Donation Form

ACB Disaster Relief

Due to the very unstable political situation in Haiti, basic necessities are very difficult for persons who are blind to obtain, and there is a very high level of food insecurity. According to Coordination Nationale de la Securité Alimentaire (CNSA), 4.9 out of 12 million Haitians are in food insecurity and this includes a higher level per capita of people with disabilities.

We are asking for emergency food assistance support for our World Blind Union country of Haiti.

Donations made through this form will directly support the Haiti Rice for the Blind Fund, which is providing relief to people who are blind and visually impaired currently impacted in Haiti.

Donation amount

Amount

$10

$100

$50

Contact Information

First Name

Last Name

Company Name

Address

Address 2

City

State/Province

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Home Phone

Cell Phone

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Payment Information

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Credit Card Information

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Card Account Number

Expiration Date

Security Code

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Same As Above

Address

City

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