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Package Name	Amount	Subtotal

Team Jane - $10	$10.00	$0.00



Team Jane - $25	$25.00	$0.00



Team Jane - $50	$50.00	$0.00



Team Jane - $100	$100.00	$0.00



Team Jane - $250	$250.00	$0.00

Other Donation Amount:

Total:

$0.00

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I authorize MercyOne Des Moines Foundation to use the credit card entered on the submission page at event. Once the transaction has completed successfully, a confirmation receipt will be sent to the email address entered.

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