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Allegany County United Way
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Adoption Form
5th Annual Duck Derby Adoption Form
*First Name
*Last Name
*Phone Number
*Email Address
*Mailing Address
*Number of ducks I would like to adopt
Please register my duck(s) in the name:
*Total amount of donation for the Duck Derby
Complete Adoption Form is required to assign specifically numbered ducks. Information will also be used to contact winners. YOU DO NOT HAVE TO BE PRESENT TO WIN!
Click Submit for online payment.
Enter the code shown above in the box below
(Items marked * are required)

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