Please fill in the form below to submit your report. If you are a member of group, your group steward should submit this form. Be sure you use the same name and email address that you joined with.

If you are making your pledges monthly or annually, please enter all amounts since your past report and use the most recently ended quarter as a date (March 31, June 30, Sept, 30 or Dec 31) Thanks for your participation.

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Name:*

of group (or individual) donating

Email:*

of the person reporting

For the Quarter Ending on*

Amount collected*

Number of people reporting*

For individuals please enter "1"; for groups enter the number participating this quarter.

Funds were used for or donated to:

We will tally results from all participants and post the results on this website. Results will be presented in aggregate to protect confidentiality.

May we list your name and donations on this website?

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