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Janus Youth Programs

Donation Form

Donation Amount:

$50.00$100.00$250.00$500.00$1,000.00

I would like my donation to recur:

Yes

Amount you would like to recur:

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Date of your final recurring donation:

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June 2018
	S	M	T	W	T	F	S
22	27	28	29	30	31	1	2
23	3	4	5	6	7	8	9
24	10	11	12	13	14	15	16
25	17	18	19	20	21	22	23
26	24	25	26	27	28	29	30
27	1	2	3	4	5	6	7

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I would like to designate to a more specific program or service (e.g. Food Works, Yellow Brick Road, etc.):

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I would like to remain anonymous:

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