HACU Donor Form

make a donation

National Headquarters

4801 NW Loop 410, Suite 701
San Antonio, TX 78229
210-692-3805 (Main)

One Dupont Circle N.W. Suite 430
Washington, D.C. 20036
202-833-8361 (Main)

1107 9th Street, Suite 850
Sacramento, CA 95814
916-442-0392 (Main)

(210) 692-3805

*Required fields are indicated by an .**
* First Name
* Last Name
* Address
* City
* State
* Zip code
Country
* E-mail Address
Phone Number (Numbers Only, No Spaces or Special Characters)
If you received a scholarship from HACU or participated in an internship or program, then you are automatically a member of HAA.
* HACU Alumni Association (HAA) member?	Yes No

* Recognize my gift as (choose one):	listing the name shown above; as Anonymous Other
Other	If selected "other" above, please enter the name desired.
I would like to make a gift to HACU in the amount of:
* Choose one	$50 Friend of HACU $100 Patron's Circle $150 Partner's Circle $250 Benefactor's Circle $500 Advocate's Circle $1,000 President’s Circle $2,500 Leader's Circle $5,000 Champion's Circle Other
Credit Card Information
* Name	Name as it appears on the credit card
*Billing Address
*Billing Zip
Type
* Card Number	Credit Card Number
* Card Security Code	Card Security Code
* Exp. Date	mm/yyyy
The amount of your gift will automatically be applied to your credit card. Thank you for your contribution to HACU. All contributions are tax-deductible to the extent provided by law.
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