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:
IMPORTANT: THIS FORM DOES NOT MAKE YOUR PAYMENT.
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