Affiliate Application Form

Thank you for choosing to join the Project Vision Hawai‘i dba Hawaiian Eye Foundation Volunteer Affiliate Program! Please complete the form below:

Contact Information

Name

First Name

Last Name

Verify Email

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Phone

Amount

$100 - 2-Year Membership: USA, Australia, New Zealand, Western Europe, Canada, Japan

$200 - 4-Year Membership: USA, Australia, New Zealand, Western Europe, Canada, Japan

$300 - 6-Year Membership: USA, Australia, New Zealand, Western Europe, Canada, Japan

$10 - 2-Year All Other Countries

$20 - 4-Year All Other Countries

$30 - 6-Year All Other Countries

Donation Schedule

Add 3% to my total amount to help cover the payment processing fees