Name: {Name (First):2.3} {Name (Last):2.6}

Address: {Address (Street Address):3.1} {Address (Address Line 2):3.2}

City: {Address (City):3.3}

State/Province: {State:22}{Province/Territory:24}{Province/Region:25}

Postal Code: {Zip Code:23}{Postal Code:26}

Country: {Country:108}

Phone: {Phone:53}

Email: {Email:5}

Member Number: {Member Number:102}

What prompted you to renew: {What prompted you to renew?:14}

Membership Level: {Donation amount*: (All donations are charged in U.S. dollars) US D:59} {Donation amount*: (All donations are charged in U.S. dollars) Int D:65}

Premium Requested: {Thank You Gift?:110}

Total Donation to be Charged: {Total:93}

Name: {Name (First):2.3} {Name (Last):2.6}

Address: {Address (Street Address):3.1} {Address (Address Line 2):3.2}

City: {Address (City):3.3}

State/Province: {State:22}{Province/Territory:24}{Province/Region:25}

Postal Code: {Zip Code:23}{Postal Code:26}

Country: {Country:108}

Phone: {Phone:53}

Email: {Email:5}

What prompted you to renew: {What prompted you to renew?:14}

Name: {Gift Recipient Name (First):10.3} {Gift Recipient Name (Last):10.6}

Address: {Gift Recipient Address (Street Address):11.1} {Gift Recipient Address (Address Line 2):11.2}

City: {Gift Recipient Address (City):11.3}

State/Province: {Gift Recipient State:27}{Gift Recipient Province/Territory:29}{Gift Recipient Province/Region:30}

Postal Code: {Gift Recipient Zip Code:28}{Gift Recipient Postal Code:31}

Country: {Country:109}

Phone: {Phone:53}

Email: {Gift Recipient Email:12}

Member Number: {Member Number:102}

Donation:{Donation amount*: (All donations are charged in U.S. dollars) US G:71} {Donation amount*: (All donations are charged in U.S. dollars) Int G:72}

Premium Requested: {Thank You Gift?:110}

Total Donation to be Charged: {Total:93}