Hands Up for Haiti Donation Form

 

IMPORTANT NOTE:  If you are donating for a specific volunteer's upcoming medical trip, please include the volunteer's name in field below.

Volunteer Name

Gift Information

Donation Amount*
$

Tribute Giving Options

If you'd like to give in honor or memory of someone else please fill out the following fields.  If you'd like to let them know of your gift, please include their email or mailing address and we'll let them know of your gift in their honor.

Tribute Name
Tribute Email or Address

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*



ALL DONATIONS ARE IN US DOLLARS

If you wish to donate to a Canadian organization on HUFH's behalf, please donate to Bridges of Hope and designate HUFH. 

Payment Information

Amount*
$
Name on Card*
Card Number*

Share This Form

Powered by eTapestry.