Military Family Relief Fund
	= Required Field
Please provide the following information.
	Title
	Select a Title -------------- Mr. Mrs. Ms. Dr.
	First Name
	First Name is required Alpha Characters Only
	Middle Initial
	Alpha Characters Only
	Last Name
	Last Name is required Alpha Characters Only
	Street Address 1
	Street Address 1 is required
	Street Address 2
	City
	City is required Alpha Characters Only
	State
	Select a State ----------------- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State is required
	Zip Code
	Zip Code is required Zip Code is invalid
	County
	Select A County --------------- Out of State Adams Allen Bartholomew Benton Blackford Boone Brown Caroll Cass Clark Clay Clinton Crawford Daviess Dearborn Decatur Dekalb Delaware Dubois Elkhart Fayette Floyd Fountain Franklin Fulton Gibson Grant Greene Hamilton Hancock Harrison Hendricks Henry Howard Huntington Jackson Jasper Jay Jefferson Jennings Johnson Knox Kosciusko Lagrange Lake Laporte Lawrence Madison Marion Marshall Martin Miami Monroe Montgomery Morgan Newton Noble Ohio Orange Owen Parke Perry Pike Porter Posey Pulaski Putnam Randolph Ripley Rush Scott Shelby Spencer St. Joseph Starke Steuben Sullivan Switzerland Tippecanoe Tipton Union Vanderburgh Vermillion Vigo Wabash Warren Warrick Washington Wayne Wells White Whitley County is required
	Phone (###-###-####)
	Phone is required Phone number is invalid format
	Donation Amount (minimum donation is $5.00)
	Select a Donation Amount ---------------- $1000 $500 $250 $100 $50 $25 $10 $5 Other Donation amount is required
	Invalid Characters Or Amount must be $5.00 or greater Invalid Dollar Amount Entered
	Email
	Email is required Email Address is invalid
	In Honor/Memory Of
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