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You are authorizing the Indiana University Foundation to initiate the payment card charge as indicated on this form. You understand that a record of each donation will be included on your monthly credit card or bank statement and that the IUF will send a receipt showing the total of all recurring gifts for the calendar year following the end of each calendar year.

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Gifts will be administered by the Indiana University Foundation, which represents Indiana University, including the IU School of Medicine. This is not a gift to Indiana University Health, and the Indiana University Health Foundation will not play a role in administering these accounts.

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