Charity donation

Thank you very much for showing your generosity and appreciation. We greatly appreciate your help and support!

CHARITY DONATION FORM

Name*
First Last
Email*
Phone*
Address*
Street Address City State ZIP Code
Charity Donation
- Silver $100.00
- Gold $200.00
- Diamond $300.00
Charity Donation
Total
$0.00
When you click 'SUBMIT' you will be taken to PayPal page for completing the payment. You may sign in to your PayPal account(if you have one) or use the option "Credit/Debit Card Payment". When you complete the payment, PayPal will send you a payment confirmation email. AZINA will also send an email. Please save both emails for your records.