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Name
Title
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Phone
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How did you hear about CHI? [Check one]
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Type of Organization [Check one]
Academic
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Number of Active Donors:
under 5,000
5,000 to 50,000
over 50,000
Donor Base and/or Service Area:
international
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Do you currently have some form of monthly program?
monthly statements
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How do you currently fund raise? [Check all that apply]
Telemarketing
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Other