MAKE A SPECIAL CONTRIBUTION TO AHHA


Use this form if...
  • You are currently an AHHA member and wish to make an additional contribution.
  • You are not currently an AHHA member and wish to make a special contribution without becoming a member.
You can use the submittal form on this page to fill out and submit the information online
OR
You can download and printout a submittal form to fill out and mail in.

GENERAL INFORMATION:
This contribution is from an individual a company
Full Name:
Organization:
Street Address:
City:
State:
Zipcode:
Country:
Work Phone:
Home Phone:
Cell Phone:
Email:
Website:
ALL INFORMATION IS KEPT CONFIDENTIAL

CONTRIBUTION INFORMATION:
AHHA is a designated 501(C)(3) nonprofit - Tax ID# 33-041271
Contributions are tax deductible as allowed by law
$ I support AHHA with this special contribution
NOTE: This indicates your intent. To actually make the contribution, you need to go to the secure server to enter credit card data OR mail a check or money order to AHHA.

SPECIAL NOTES:
Use this space to explain your wishes and provide AHHA all related details related to your contribution. You may designate this special, non-membership contribution towards a specific AHHA project or donate in memory of or in honor of a special person. For in memory of contributions - please add the name and address of someone representing the person being remembered, so that AHHA can notify of your caring and generosity. For in honor of contributions - please add the name and address of the person being honored, so that AHHA can notify of your caring and generosity.



Print out a copy of all of the above for your records, as back up in case of a technical glitch in information transfer.

SUBMIT APPLICATION INFORMATION TO AHHA:
After you click on SUBMIT button below, the data you entered above will be emailed to AHHA.
AND you will be transferred to the payment information screen.
Pick Option #1 to indicate you plan to mail a check or money order to AHHA to make your contribution.
Pick Option #2 to indicate you plan to use your credit card to make your contribution.
Method will use to make contribution