Amount	$
First Name*
Last Name*
Address *
Address 2
City *
State
Country
Zip Code *
Phone Day *
Email Address *
Project	JAFAI Helps the Disabled KidsJAFAI Helps the ElderlyJAFAI Builds Water Wells for Polio PersonsJAFAI Provides Free Mattresses for Polio PersonsJAFAI Takes Disabled on OutingsSponsor an Individual or FamilyEducational Institution