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Register

Questions: Please contact Allison Weingarten at [email protected] or 518 487-4395 ext. 22.

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Bank Account*

Name on Account*

Bank Routing Number*

Bank Account Number*

Card Number*

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Address, line 1*

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Donation will repeat monthly.

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Thank you for registering for Stand Up For Recovery Day on March 6, 2018.

Please email Allison Weingarten at FOR-NY with any questions; [email protected] or call 518 487-4395 ex.22.