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PHONE SPOUSE S NAME - LAST WT ALUMNI DOB* WORK PHONE TITLE/FIRST GENDER* COLLEGE AND ACADEMIC DEPARTMENT MI ADMINISTRATIVE DEPARTMENT MAJOR/GRAD YEAR PAYROLL DEDUCTION TITLE* SIGNATURE *optional Monthly Gift x Pay Periods per Year Total Amount New Payroll Deduction of $ 9 12 $ Change Current Gift Amount to $ 9 12 $ Change Current Gift Designation to See.

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