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Donation Form

Yes, I'd like to make a difference!

How would you like your gift used?

	Use my gift where it is needed most.
	Let my gift help children in orphanages overseas.
	Let my gift help children in
	Let my gift help families who adopt African-American and Biracial infants.
	Let my gift help birth mothers in the USA.
	Let my gift help with this specific special project.

Donation Amount

$50 $100 $250 $500 Other $

Name*
Address*
Address 2
City*
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Zip*
Phone*
E-mail*

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Adoptions From The Heart is a registered, charitable organization. In accordance with Pennsylvania Law, a copy of our official registration and financial information may be obtained from either the PA Department of State by calling, toll free within PA (800) 732-0999, or the State of NJ by calling (201) 504-6215. Registration with the NY Attorney General does not imply endorsement. A financial statement is available upon written request from the VA State of Office of Consumer Affairs (800) 552-9963.