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Add your name to the pledge (Agregue su nombre a el compromiso):
Note: After clicking "Submit" at the end, scroll up to see a "Thank You" message!
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Click the box below and fill out this form to add your name. (Haga clic en el cuadro a continuación y complete este formulario para agregar su nombre.)
*
I Pledge to Protect (Hago esta promesa)
Required
First Name / Primer Nombre
*
Your answer
Last Name / Apellido
*
Your answer
Email
*
Your answer
Address / Dirección
Your answer
City / Ciudad
Your answer
State / Estado
Your answer
Zip Code / Código postal
Your answer
Do you want your name listed below on this website? (¿Quiere usted que su nombre aparezca en este sitio web?)
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Yes / Sí
No
How would you like your name to appear? Enter Anonymous if you don't want your name listed on the website. (¿Cómo se gustaría usted que apareciera su nombre?)
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Your answer
Feel free to comment about why you're taking the pledge (to be shared on the website.) You can also send videos or pictures to
rschmidt@paxchristiusa.org
. [Siéntase libre de comentar sobre por qué está haciendo la promesa (que se compartirá en el sitio web). También puede enviar videos o fotos a
rschmidt@paxchristiusa.org
.]
Your answer
Would you like to receive information from Pax Christi USA? (¿Desea recibir información de Pax Christi USA?)
*
Yes / Sí
No
Required
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