MAID registration 2022

MAID registration form

Select a Date

First Name *

Last Name *

Email *

Phone

Address 1

Address 2

City

State

Zip / Postal Code

Your gift does so much! If you would like to support CHANA with a charitable donation, please check the box below.

Would you like to make a donation to CHANA?

Yes, I would like to make a donation

Donation Amount

$180 - pays for a week of groceries for a family of four

$100 - pays for one week of groceries for two people

$75 - covers the costs of a doctor visit for an uninsured client

$50 - pays for a doctor visit for an uninsured client

$36 - pays for transportation to and from court

$18 - pays for clothing for a client's child

Other Amount: $<strong>Other Amount: $</strong>

Cover transaction fees?

Yes, I would like to cover transaction fees so my entire donation goes to CHANA

Your Total

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