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Secure Donations

Thank you for your generous support. Your contribution will be used to help stop HIV discrimination and eliminate injustices for people living with HIV and AIDS in Southern California.

 

Please provide the requested information so that we can process your donation.

 

Title:
First Name:
Last Name:
Street:
City:
State:
Postal/Zip code:
Email:
Daytime Phone:
 

Privacy Policy: HALSA values and protects your personal information. We do not sell or share donor information with outside organizations or individuals.
 

In Memory or Tribute

If the donation is to be made in memory or in honor of someone, please provide that person's name.

In Memory of In Honor of
Name:

Please provide the full name and mailing address of anyone you would like notified of your tribute gift; along with any comments you would like us to share with them.
 
 

Contribution Today

Please enter the amount you would like to contribute today.

$50
$100
$250
$500
$1,200 (Justice Club)
Other Contribution Amount:
 

Contribute Monthly

The best way you can support our work is through a regular monthly gift, allowing us to plan more effectively through this ongoing, dependable source of income.

Please complete this section if you would like to enroll in our Sustaining Donor Campaign. Your monthly contribution will begin as of the next calendar month and will continue until you notify us.
Monthly Donation Amount: $USD
What week of the month would you like your monthly donation processed?
 

Credit Card Information

Please type the cardholder name as it appears on the credit card.

Cardholder Name:
Credit Card #:
Security Code (CVV2):
Card Type:
Expiry:
 

Comments

Feel free to send us a message with your gift. We appreciate your comments and feedback. Thank you!