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1. Amount

$

2. Your information

Law requires we ask for your employer and occupation. If you don't have an employer or are retired, put N/A, and if you are self-employed put "self-employed" in employer and describe your occupation.
Contributions are not tax deductible.

3. Payment information

I understand my contribution to Emergency Room for Richmond, 501(c)(4), is not tax-deductible as a charitable donation.
$Please select an amount
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