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$1 for One Offering

Your Name

First Name

Last Name

Your Email Address

Your Phone Number

Nominee's Story/Need (Be very specific)

Nominee's Name

First Name

Last Name

Nominee's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nominee's Phone Number

(###)

###

####

Check if nominee qualifies for this offering

Yes, this nominee is far from Christ

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