Donor Form

Name: *
Address: *
City: * State: *
Zip Code: *    
Phone: Fax:
Cell: Email: *
Donation: I would like to adopt a family for 1 year in the following manner:
  Check One Please    
 
Monthly installment $
 
Quarterly Installment $
 
Yearly Installment $
 
One time donation $
  Enter the amount of your donation *
       
I would like to receive monthly communication from my adopted family via
(check One)
  Email U.S. Mail  
       
I would not like to receive any communication from my refugee family
Once you click Submit you will be directed to a page to make you purchase through paypal. DO NOT CLOSE your browser after you submit this form.