VIP MEMBERS - UPDATE DETAILS

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EmailListID

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MasterID

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RaffleID

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RecordID

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Client

Your Heroes Club Supporter Number

Type of Support(Required)

Lottery

Donation

Both

Ticket Bundle

Donation Amount

Your Total Monthly Support

Title First Name Last Name

Phone

Email Address

Address

Street Address Address Line 2 Suburb State Postcode Country

Credit Card(Required)

American Express

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name