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The Ruth Lilly Health Education Center Please print out, complete, and mail this form with your check or money order to: The
Ruth Lilly Health Education Center Thank you for your support! Name _________________________________________________________________ Street ________________________________________________________________ City ___________________________________ State _____ Zip ________________ Telephone ______________________ E-mail
_________________________________ Amount Donated ________________________________________________________ Please check here if:
_____ I prefer not to be listed publicly as a Ruth Lilly Health Education Center
Supporter
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