Mexico Payment & Donations - 2019
Please fill out this form and click submit.
Information about YOU
For tax and accounting purposes please provide your personal information.
Name - who is paying or donating? (Should match name on card)
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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Information about YOUR Payment or Donation
Please indicate - Payment or Donation
*
Please select all that apply.
Payment (I/we will be participating on the trip)
Donation (I am supporting a member of the team)
If donating, tell us about who you are donating for
Name (who is this money designated for?)
*
Donation (1st donation)
Name (is there another person you are donating to?)
Donation (2nd donation)
Additional Notes (anything else we should know?)
Credit Card Payment
Payment
$0
Requested Receipt
*
Upload (8MB)
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Submit
Description
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