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Luxembourg American Cultural Society, Inc.
PO Box 157
775 Main Street
Belgium WI  53004-0157

U.S.A.
Tele: 262-476-5086
Fax: 262-476-5087

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Donation Form

CONTACT INFORMATION
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To make a donation to the Luxembourg American Cultural Society, please enter amount here:
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*Email: *Home Phone: ( ) -
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PAYMENT INFORMATION: (As it appears on Credit Card)  
*Card Type: Same Name & Address as:
*Card Number: Member Information, Click Here!
*Exp. Date: / Gift Form Information, Click Here!
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Please send me additional information about: (check all that apply)
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