CHARITABLE DONATION REQUEST

AIH members may complete this form so that we may consider a charity that deserves support.

AIH MEMBER'S INFORMATION

First Name *

Last Name *

Email Address *

Phone *

CHARITY RECIPIENT

Name *Name of Organization or Person(s) benefitting from the donation

Amount

USD

Enter the amount of support requested.

Explanation/Reason For The Request *

Submit Application

You may alsodownload a printable form that can mailed in.