Wheelchair Sponsorship Form

Wheelchair Sponsorship Form

 
YES! I want to give the gift of mobility to (check one)

__1 disabled person ($100)

__2 disabled people ($200)

__5 disabled people ($500)

__10 disabled people ($1000)

__20 disabled people ($2000)

__50 disabled people ($5000)

__ Other amount. Please write how much here $__________.


Your name: __________________________________________________________

*Email address (optional):___________________________________________

*Postal address: ____________________________________________________

_____________________________________________________________________

*Phone number (optional): ___________________________________________

Method of payment (check one):

___Check enclosed, payable to Kham Aid Foundation

___Visa/Mastercard. Name on account: _____________________________

     Account number:___________________________ Exp. Date:________

     Billing address:______________________________________________

___ I want my wheelchairs to go ONLY to ethnic Tibetans.
___ Add me to your e-mail list.

Print this page and mail to: 900 Wilshire Blvd., #1138, Los Angeles, CA 90017
Or fax to: 1 626 628-3109.
Or email to: khamaid@khamaid.org               
For questions, please call 1 626 449-7505.

All contributions are deductible for U.S. taxpayers