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Purpose of this donation/payment:
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CCHF General Fund
CCHF Clinic Membership Fees (or Gift)
CCHF Conference or Exhibitor Registration
Student Programs (Enables CCHF to reach health profession students)
MCO Philadelphia - general fund
SMI Philadelphia - general fund
SMI Student Scholarship fund (enter details in comment box)
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Comments or instructions?
Use this space to provide additional details for the purpose of your donation. Is your gift in someone's honor? (If so, provide that info here with the address for acknowledgements.)
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