Houston Community WCSD Donation Form

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Thank you for your donation to the Houston Community White Cane Safety Day committee.

Please fill out this form to submit your intent to donate using the Square payment service.

After completing this form, you will be redirected to the payment service, which will allow you to complete your transaction. You will also receive two emails, one with the confirmation of your form submission and one with the payment link.

If you have any questions, please contact Louis Maher ("Houston.Community.WCSD@gmail.com", 713-444-7838).

Email *

Confirm your email *

Organization name (Enter "None" for a personal contribution) *

Your first name *

Your last name *

Your phone number *

Your donation amount *

$5 donation

$10 donation

$25 donation

$50 donation

$100 donation

$250 donation

$500 donation

$1,000 donation

Reason for your donation *

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