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Wadsworth Bruin Patron Drive

Additional Donation Enter $ Amount

Bronze Circle $40-$50 Enter $ Amount

Silver Circle $51-$75 Enter $ Amount

Gold Circle $76-$99 Enter $ Amount

Platinum Circle $100 or more Enter $ Amount

First Name *

Last Name *

Email *

Street Address * (For delivery of the paper)

City *

State *

Zip Code *

Name of Bruin Staff Member who registered you as a Patron (if applicable)