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Donation

* Mandatory fields
Prefix
*Last name/Nom
*First name/Prenom
Middle Name/Surnom
*e-Mail/Courriel
*Phone/Telephone
*Home: Street Address/Rue
Enter Street Address
Home: Apt/Suite No.
Enter Suite or Apt. Number
*Home: City/Ville
Enter City
*Home: Zip Code/Code Postal
Pour Haiti utilizez le code: 01509
International Countries use code: 11101
Short BIO or Additional Comment
Select Project for your Donation
*Other Amount ($USD)
Please enter other your amount in this format (0.00)
Source
If your donation is connected to a specific group, please identify the group name.
 Payment frequency
Comment
 


Association Medicale Haitienne A L'Etranger
Haitian Medical Association Abroad

Contact about this page: mdbruno@amhecec.org


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