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SCAIPC Outreach - Donation Form 2014
  1. Please enter the information below and click the submit button
  2. Name(*)
    Please type your full name.
  3. Organization
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  4. Date
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  5. Website
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  6. E-mail(*)
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  7. Check Donation:
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    If this is a monetary donation to be paid by check, please list the amount
  8. Paypal Amount
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  9. Paypal Total
    0.00 USD
  10. Service Donation:
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    What is the service being donated?
  11. Service Value
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  12. Donation Description
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  13. Can we share your story with SCAIPC members?
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  14. Please retype these letters:
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  15. We would like to THANK YOU for your donation! Please be assured that your donation to the South Carolina Aging in Place Outreach Fund will be used directly to support a senior in our community to help them successfully age in place. Funds will distribute according to our guidelines found on the website.
    Please send this form with a check payable to SCAIPC – Outreach and mail to:
    South Carolina Aging in Place Coalition
    147 Wappoo Creek Drive, Suite 105, Charleston, SC 29412