AFRICA HANDICAP RELIEF FUND, INC. (AHRFI)

2631 ARLINGTON DRIVE, SUITE 301

ALEXANDRIA, VIRGINIA 22306 USA

PHONE: (571) 338-7519

www.africa-handicap-relief.org

Today’s Date: ______/_____/_____ (Month/Day/Year)

INFORMATION ABOUT YOU THE DONOR

Name: Dr./Mr./Mrs./Rev./Chief: _______________________________________________

Address: _________________________________________________________________

City: _______________________ State:_____________ Zip ________

Home phone: (_____) _____ - ________ Work phone: (_____) _____ - ________

Email address: _____________________________ ___Include me in your mailing list.

YOUR DONATION – Mail Your Donation To The Address Above
Amount ($):	_______________ ___Publish my gift on your website.
Targeted Giving (Note 1: Leave all unchecked if you want AHRFI to channel funds to its current projects):	___Medical Bills ___Tuition Assistance ___Fresh Water ___Medical Center ___Charitable Agency ___Other, Specify:
Targeted Location (See Note 1 above):	___Africa ___USA ___Other, Specify:

MANY THANKS

Thanks very much for your support. Half of the funds we have received to support the needy has come from individuals like you. Corporations and other companies have provided the other half. Your continued support to this worthy cause will ensure AHRFI will continue to help the needy. Thanks again.