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):101}
Phone: {Phone:53}
Email: {Email:5}
Heard About STC: {Where Did You Hear About STC?:14}
Donation Amount: {Total:93}
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