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2. First Name*
3. Last Name*
5. Address1*
7. Address2
9. City*
10. State*
11. Zip*
13. Email*
15. How Many Fence Pickets Would You Like to Purchase?*
    Cost per picket is $50.00.
17. Picket 1 requested engraving*
    Each picket can have up to 17 characters and/or spaces.
19. Picket 2 requested engraving
    Each picket can have up to 17 characters and/or spaces.
21. Picket 3 requested engraving
    Each picket can have up to 17 characters and/or spaces.
23. Picket 4 requested engraving
    Each picket can have up to 17 characters and/or spaces.
25. Next Steps
    Once you have submitted this form, payment will need to be made directly to the Midland Area Community Foundation. You can contact them at 989-839-9661 to arrange for payment.
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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field