Corener Hines Scholarship Fund
Full Name
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Business Name
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Business or Personal Mailing Address
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City, State, Zip
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Phone Number
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Your Email Address
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Scholarship Donation
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Donation (Add $50.00)
Donation (Add $100.00)
Donation (Add $250.00)
Donation (Add $500.00)
Donation (Add $1,000.00)
Other Amount
Total
$
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