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Association of Jamaican Nurses of Greater Houston Donation Form
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Email
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1. Date
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2. Name
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3. Address: Street Number/Name/Apt/City/State/Zip
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4. Cell Phone
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5. Select your Option(s) for your Donation
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Donation to AJN-Greater Houston Scholarship Fund
Donation for Scholarship in the name of ________ (Type in the name below.)
Donation for Scholarship in Memory of __________ (Type in the name below.)
Donation to Mission _____________ (Type in the name below.)
Donation to Cause _____________ (Type in the name below.)
Donation to General Fund
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6. Provide Name for Scholarship / Cause
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7. Donation Amount
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7. Payment Options
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Check payable to: Association Jamaican Nurses-Greater Houston. Mail to: PO Box 1803, Alief, TX 77411
Zelle:
houstonajn@gmail.com
or click on QR code
Mailing Address: Association of Jamaican Nurses of Greater Houston, PO Box 1803, Alief, TX 77411
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