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Item Information

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Item Description:*

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Notes:

Are you willing to double your donation if it goes for value?*

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I am a(n):*

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Restrictions and/or Redemption Contact Info:

Item Delivery Method:

I will deliver or mail my gift to APDA Office

Gift is available for pick up (mail or deliver if possible)

APDA to create a gift certificate, details included on form

Certificate is being emailed to apdanw@apdaparkinson.org

Contact Information

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Address2:

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