Gala Donation Gala Donation Amount: Amount: Designation Designation: 2019 Summer Gala Billing Address Make this gift on behalf of an organization Organization name: Name: Title: First name: Last name: Email: Phone: Country: United States Canada United Kingdom Hong Kong Ireland Serbia Address: City: State & zip: State: state AA AB AE AK AL AP AR AS AZ BC CA CO CT CZ 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 NL NH NJ 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 Zip: City & county: City: County: county (optional) Accomack Addison Aiken Alachua Alamance Alameda Albany Albemarle Alexandria City Allegheny Amador Anderson Androscoggin Anne Arundel Arapahoe Arlington Aroostook Atlantic Augusta Baldwin Baltimore Baltimore City Barnstable Bay Beaufort Belknap Bennington Benton Bergen Berkeley Berks Berkshire Bernalillo Berrien Bexar Bibb Blue Earth Boone Boulder Bradford Brevard Bristol Bronx Broome 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