Donate Money to Aid for AIDS

Donors are a very important part of AFA and we welcome your assistance in donating money to help our cause. Please take a moment to fill out this form completely. This information will be used to contact you and ask you more detailed information about your donation.


Please provide the following contact information:

First Name:
Last Name:
Street Address:
City:
State:
Zip:
Work Phone:
Home Phone:
Fax:
Email:


Donation Amount (US Dollars):

$25
$50
$100
$250
$1,000
other $


Best time to reach you:
Comments:

How did you hear about Aid for AIDS?
    Newspaper or Magazine article
    Advertisement
    Public Service Announcement
    Postcard
    Press kit
    Poster
    Another Website
    Word of mouth
    Other: