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Donation Amount:

$ 5,000.00

Legacy 1 Year
Legacy Lifetime

Legacy 1 Year : Your membership cost will be valid for a year and needs to be renewed at least for another 2 years before your Lifetime membership kicks in.

Legacy Lifetime : Your membership cost is a one-time payment and is valid for a lifetime membership with Synergy.

Personal Info

First Name *

Last Name

Designation *

Name of the business *

Year business was established *

Business website URL *

Email Address *

Phone *

Credit Card Info

This is a secure SSL encrypted payment.

Card Number *

CVC *

Cardholder Name *

Expiration *

Donation Total: $5,000.00

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