1100 W. 42nd St., Ste. 125, Indianapolis, IN 46208 Tel: (317) 203-0603; Fax: (317) 522-1548

www.obathelpers.org Email: contact@obathelpers.org

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Support OBAT to transform lives

Donation form - 2017

First/Last Name:

Phone: ( )

Address:

City: State: Zip:

Email:

Please find enclosed US $ � Donation � Other __________________ Donation Method: � Credit Card � Check (check #: ___________) � Cash

Credit Card Type: � Visa � Master Card � Discover � American Express Credit Card #: Exp. Date (Month/Year): ______/_______ Name of Card Holder: CVV (3 #’s on back): ________ Date: Signature of Card Holder: *Please add 3% for credit card processing fee

*Please see back of form for more details

1100 W. 42nd St., Ste. 125, Indianapolis, IN 46208 Tel: (317) 203-0603; Fax: (317) 522-1548

www.obathelpers.org Email: contact@obathelpers.org

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I designate my donation to: Please select one or more of the following: (amount dependent on size/nature of services) Where it is needed most Help to support basic needs: For food, clothes, and emergency medical

assistance: $50-$300 per person. Educational Aid & Scholarships: $250-$2,000 per year will help one student

continue his/her education in a school/college/professional education program. Economic Empowerment: $250-$2,000 will help a family become empowered

financially. Family Assistance Program: $300-$600 per year will provide assistance to a family

for basic needs for one year. Water and sanitation facilities: $5,000-$8,000 for drinking water, sewage facilities

and construction/rebuilding of bathrooms. Educational programs in camps: $4,500-$25,000 per year. Please indicate your

preferred program below.

Preschool Elementary/Middle/High School Tutoring center Working children & adult literacy program Computer training center

Vocational training for women Health Clinic: $15,000 - $25,000 per year can run/build a facility staffed with part

time doctors, compounders and provide medicines to thousands of people. Cataract Surgery: $40 per person can bring vision back to one sightless person. Maternity/delivery services: $100 per woman Other: Please specify:

________________________________________________________________

Special instructions:

Please make check payable to OBAT Helpers Inc. and mail it to the address below. You can also pay online using our website: www.obathelpers.org.

OBAT Helpers is a non-profit, charitable 501(c) (3) organization; tax ID#: 47-0946122