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Disaster Assistance Fund
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Donation For
(Required)
Disaster Assistance General Fund
Specific Event or Area/Locality
Kiwanis Club Name (if donation from club)
Not a Kiwanis Member
Abingdon
Accomack, Onancock
Alexandria
Alleghany Highlands
Arlington
Ashland
Baltimore City
Bassett
Bel Air
Bethesda
Blue Ridge, Winchester
Bluefield
Botetourt County, Troutville
Bridgeville
Bull Run-Manassas
Canton-Fells Point
Capital Legacy eClub
Capital Next Generation e-Club
Capitol Hill, Washington
Carrollton
Central Chesterfield
Charlottesville
Chesapeake
Chester
Chilhowie
Chincoteague
Christiansburg
Churchland, Portsmouth
City Center Newport News
Clinch River, Richlands
Clinchco
Clintwood
Coastal Delaware
Coeburn
Colonial Capital, Williamsburg
Colonial Heights
Commodore Mayo, Mayo
Council
Crewe
Crofton
Danville
Delmar
Denbigh, Newport News
Dinwiddie
Dover
Downtown Hampton
Eastern Branch, Washington
Elkton
Ellicott City
Fairfax
Far East Washington
Forest
Fort Hill, Lynchburg
Frederick, MD
Fredericksburg
Front Royal
Georgetown
Giles County
Gloucester
Grafton
Great Bridge-Chesapeake
Greater Hilton
Greater Landover
Greater Millsboro
Greater Ocean Pines-Ocean City
Grundy
Hagerstown
Hampden-Midtown, Baltimore
Harrisonburg
Haysi
Hopewell
Hurley
Leesburg
Leisure World, Silver Spring
Loch Raven
Lynchburg
Lynnhaven-Virginia Beach
Manassas
Marion
Martinsville
McClure River
Mercury 64, Hampton
Middlesex, Saluda
Midlothian-Chesterfield
Mitchellville
Montgomery County-Blacksburg
Montgomery Village
Mount Airy
Mount Vernon, Fairfax County
New Kent
Norfolk
Northern Neck-Kilmarnock
Northwest Washington
Norton
Ocean View Beach, Norfolk
Old Point Comfort, Hampton
Old Town
Orange County
Peninsula at Oyster Point, Newport News
Petersburg
Pocomoke City
Poquoson
Portsmouth
Prince George's County
Radford
Reisterstown
Richmond
Roanoke
Rockville
Salem
Seaford
Severna Park
Shenandoah Valley, Staunton
Shepherd Park, Washington
Smithfield
South Arlington
Southwest Waterfront Washington DC
St Paul-Castlewood
State Line, Maryland
Staunton
Strasburg
Suffolk
Tappahannock
The Jackson River Area
Toano
Towson-Timonium
Tuckahoe, Richmond
Tysons
Virginia Beach
Virginia Beach Virginia, Town Center
Virginia Beach-Combers
Waldorf
Washington
Waynesboro
Westminster
Wheaton-Silver Spring
Williamsburg
Wilmington
Winchester
Wise
Woodbridge
Wythe County
Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Division
(Required)
Not a Kiwanis Member
Don't Know
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
Your Club Name (if you belong to a Kiwanis Club)
Not a Kiwanis Member
Abingdon
Accomack, Onancock
Alexandria
Alleghany Highlands
Arlington
Ashland
Baltimore City
Bassett
Bel Air
Bethesda
Blue Ridge, Winchester
Bluefield
Botetourt County, Troutville
Bridgeville
Bull Run-Manassas
Canton-Fells Point
Capital Legacy eClub
Capital Next Generation e-Club
Capitol Hill, Washington
Carrollton
Central Chesterfield
Charlottesville
Chesapeake
Chester
Chilhowie
Chincoteague
Christiansburg
Churchland, Portsmouth
City Center Newport News
Clinch River, Richlands
Clinchco
Clintwood
Coastal Delaware
Coeburn
Colonial Capital, Williamsburg
Colonial Heights
Commodore Mayo, Mayo
Council
Crewe
Crofton
Danville
Delmar
Denbigh, Newport News
Dinwiddie
Dover
Downtown Hampton
Eastern Branch, Washington
Elkton
Ellicott City
Fairfax
Far East Washington
Forest
Fort Hill, Lynchburg
Frederick, MD
Fredericksburg
Front Royal
Georgetown
Giles County
Gloucester
Grafton
Great Bridge-Chesapeake
Greater Hilton
Greater Landover
Greater Millsboro
Greater Ocean Pines-Ocean City
Grundy
Hagerstown
Hampden-Midtown, Baltimore
Harrisonburg
Haysi
Hopewell
Hurley
Leesburg
Leisure World, Silver Spring
Loch Raven
Lynchburg
Lynnhaven-Virginia Beach
Manassas
Marion
Martinsville
McClure River
Mercury 64, Hampton
Middlesex, Saluda
Midlothian-Chesterfield
Mitchellville
Montgomery County-Blacksburg
Montgomery Village
Mount Airy
Mount Vernon, Fairfax County
New Kent
Norfolk
Northern Neck-Kilmarnock
Northwest Washington
Norton
Ocean View Beach, Norfolk
Old Point Comfort, Hampton
Old Town
Orange County
Peninsula at Oyster Point, Newport News
Petersburg
Pocomoke City
Poquoson
Portsmouth
Prince George's County
Radford
Reisterstown
Richmond
Roanoke
Rockville
Salem
Seaford
Severna Park
Shenandoah Valley, Staunton
Shepherd Park, Washington
Smithfield
South Arlington
Southwest Waterfront Washington DC
St Paul-Castlewood
State Line, Maryland
Staunton
Strasburg
Suffolk
Tappahannock
The Jackson River Area
Toano
Towson-Timonium
Tuckahoe, Richmond
Tysons
Virginia Beach
Virginia Beach Virginia, Town Center
Virginia Beach-Combers
Waldorf
Washington
Waynesboro
Westminster
Wheaton-Silver Spring
Williamsburg
Wilmington
Winchester
Wise
Woodbridge
Wythe County
Donation Amount
(Required)
Total
Credit Card
Card Details
Cardholder Name
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