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Complete the form below to make a donation for Juliet Stipeche for HISD School Board.

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Donation Amount:
Payment Method:

First Name: (r)
Last Name: (r)
Company:

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Address Line 2:
City / State / Zip:	/ /
Country:	(US, UK, FR, DE ?)

Phone Number: (r)
Email: (r)
Email Receipt:

Referred by:
Comments: