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Arkansas Liberty Summit 2013

Your generous donation will go towards advancing liberty in the state of Arkansas. Donations of $20.00 or more come with an Arkansas Liberty Summit t-shirt* which you can pick up at the event.

*View the t-shirt here: http://i.imgur.com/o8JVf.png

Contribution Amount

$10 - T-Shirt (Student Price)
$20 - T-Shirt
$30
$50
$100
$200
$500
$

Personal Information

First NameRequired
Last NameRequired
EmailRequired
Home AddressRequired
Home Address (line 2)
CityRequired
StateRequired
Zip/PostalRequired
Phone NumberRequired

Employment Information

EmployerRequired
OccupationRequired

Payment Information

Debit/Credit Card

Card Number
CSC ?
Expiration

Routing Number
Account Number

Billing Information

Same as home address.
Billing Address
Billing Address (line 2)
City
State
Zip/Postal

I want to publish my name to the Arkansas Liberty Summit 2013 giving stream! (Note: your contribution amount will not be shown)

Your donation will appear on your credit card or bank statement as "RALLY/PIRYX"

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