Yes, I want to make a difference in Africa. I am making a gift of:
____$20 ____$30 ____$50 ____$75 ____$100 ____$200 ____$500 ____$1,000
or $_____________ (Please indicate amount.)
Please fill in the following and we will send you a receipt for tax purposes. Check here if you would accept your receipt in email: ____
Phone (optional): __________________________________________________
Email (optional): ___________________________________________________
If donating by check, please make payable to HealthLink for Africa International Inc.
If donating by credit card, please fill in the following:
Account #:_________________________________ Exp Date:____________
Name as it appears on your card: _____________________________________
Signature: ________________________________ Date: _________________
Please mail this form to:
HealthLink for Africa International Inc.
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A copy of our latest annual financial report may be obtained upon request from the Office of the Attorney General, Charities Bureau, 120 Broadway, New York, New York 10271, or by direct request to HealthLink for Africa International Inc.