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New Donor Pledge

- The maximum number of form submissions has been reached. This form is currently not available.
  
  I wish for my donation to remain anonymous. Click Here
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  If Donation by a Business, Please List Corporation Type (Ex: LLC, C Corp, etc.) Please enter valid data.
  
  If Donation by a Business, Please List Tax Year End Date
  mm/dd
  Please enter a date.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter valid data.
  
  Pledge Fulfillment amount REQUIRED Please fill out this field. Please enter an integer (number).
  
  The state of Iowa requires that we have your S.S.# to issue your tax credit certificate.
  Upon completing this form, please contact Steve Kane, Director, at (563) 556-2580 x296 to provide your social security number.
  
  Submit
  
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