Legislative Advocacy Contribution Form
Massachusetts Association of Private Career Schools
School/Company
*
Address --
*
City
*
State --
*
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AL
AK
AZ
AR
CA
CO
CT
DC
DE
FL
GA
HI
ID
IL
IN
IA
KS
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LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
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NY
NC
ND
OH
OK
OR
PA
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TN
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Zip Code --
*
Phone --
We will contribute
*
Payment
*
Master Card
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Please check your credit card payment choice.
Please charge my credit card for the full amount.
Please charge my credit card in quarterly installments.
Please charge my credit card in two installments
First Name
*
Last Name..
*
Email
*
Account #
Security Code
Expiration Month
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01
02
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12
...Expiration Year
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2000
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2015
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2021
2022
2023
2024
2025
2026
2027
2028
2029
2030