Payment Form

Payment Information

Select Amount

$25 - MYEF Members
$40 - Non MYEF Members

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Purpose

Contact Information

Title

First Name

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Last Name

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Address

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Address 2

City

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State

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Zip Code

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Address Type

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Phone

Email

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Credit Card Information

Card Name

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Card Type

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Card Number

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Expires

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* Card Code

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Card Address

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Card Zip Code

*

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