The National Council for Behavorial Healthcare

Project Helping Hands Donation Form

Donate to Help Mental Health Efforts in Haiti
Many mental health needs are expected to emerge in the aftermath of the devastating earthquake in Haiti on January 12, 2010. The National Council's Project Helping Hands supports mental health efforts in Haiti and for Haitian populations in the U.S. Your donation will help us meet the need.

The National Council for Community Behavioral Healthcare is a 501(c)(3) not-for-profit association. EIN# 23-7092671. Your donation is tax-deductible in the United States. We will send you a receipt within a week of receiving your donation.

Make a donation online now using the secure form below. You may also call 202.684.7457 or mail this form, along with your check, to the National Council for Community Behavioral Healthcare, 1701 K Street NW, Suite 400, Washington DC 20006.

DONATE ONLINE

* = indicates required field

Amount of Donation* $500 $250 $100 $50 $25 Other

First Name*
Last Name*
Title
Organization
Address
City
State
Zip
Country
Phone
Fax
Email

Send my receipt via (check one)

Email Mail

Payment Information

Card Type
Card Number*
First Name on Card*
Last Name on Card*
Expiration	/
Security Code*

Billing Address*
Billing City*
Billing State*
Billing Zip*
Comments

Questions? Call 202.684.7457 or email Communications@thenationalcouncil.org