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Donation Information
Amount:	$ 500.00 $ 250.00 $ 100.00 $ 50.00 $ 35.00 $ 30.00 $ 25.00 $ 20.00 $ 10.00 Other $     *
Designation:	Children's Hospital Fund Other
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Type of gift:	One-time gift Recurring gift
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Title:	Dr. Dr. and Mr. Dr. and Mrs. Drs. Mr. Mr. and Mrs. Mrs. Ms. The Family of
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