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Project AHAVA

Full Name
First NameLast Name
E-mail
I'd like to nominate the following family for a special love package:
Recipient Name
First NameLast Name

Recipient Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

This family or individual had recently:
Moved to townLost a loved oneHad a babyNeed support during a health challenge
I would like to support toward this project:
$25$50$100
Total
$0.00

Credit Card Paypal eCheck

Postal / Zip Code

Country

Volunteer:
Yes, I would love to help put together a love packageYes, I would love to help deliver a package (based on my availability)
I would like to receive news and updates by email
Should be Empty:

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