Give $20 Contribution Form

Pay it forward! Use this form to give $20 or more to support important federation funds between May 1 and July 6 3:00 p.m. central time and be entered into the Give $20 Convention Drawing. Your name will be placed in the drawing for each increment of $20 you give. Give $100 and you will be entered into the drawing five times. It’s a win win!

Winner does not need to be present to win. Please include your phone number and email address so we can contact you.

How to Give

Please choose any of the funds to support. If you are not sure of a fund, please use the White Cane Fund. If you have questions, please contact [email protected].

You are completing this form on behalf of someone else. Please enter their details.

Kenneth Jernigan Fund (to support first-time convention attendees):

tenBroek Fund (to support the Jernigan Institute building in Baltimore for the benefit of blind people):

SUN Fund (rainy day fund):

White Cane Fund (general donation fund):

Total Amount

Giving 20 Donor Information

First Name *

Last Name *

Donor Email

Donor phone number *

Country

Street Address *

Street Address 2

City *

State

Postal Code *

Comment

Credit Card

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *