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Support UCP:

September 25, 2006

UCP AffNet Entrance [password required]

YES! I want to make a secure online contribution to UCP to help people with disabilities to live independent and productive lives.

Fields marked with an asterisk (*) are required for processing the donation.

Step 1: Donation Information

(You will be prompted to identify an affiliate.)

b)* I would like to make a gift of:

Other Amount:
(eg. 10000.00)

Step 2: Your Information

a) Title
b)* First Name
c) Middle Initial
d)* Last Name
e) Company Name
f)* Address
g)* City
h)* State or Province
i)* Zip
j)* Country
k)* E-Mail Address
l)* Phone Number
You will only be contacted by phone if there is a problem with your transaction.

Step 3: Credit Card Billing Address
If your Credit Card Billing Address is the same as the address listed in Step 2, you may skip this step.

Step 4: Donation Honoree

I would like to make this donation

Name:
Please notify the following person(s) of my donation.
Name:
Address:
City:
State:
Zip:
E-mail:

Step 5: Additional Information

b) Yes, I am interested in receiving updates on UCP's work via e-mail.