Yes, I want to sponsor a child.

I want to sponsor a child to participate in the ULTRA Teen Choice Service Club at a public school in Washington, DC for just $32 per month
Please apply my sponsorship to any eligible child.
I would like to sponsor a specific child. Please select a child for me.

I want to give an additional monthly contribution to ULTRA's HIV/AIDS and teen pregnancy prevention education program in the amount of:
$8 
$16
$32
$64
$100

Number of months you wish to pay for now:
One Month
Three Months
Six Months
One Year

Your information will be transmitted by a secure connection.

I prefer to make my first payment by credit card.
Credit Card
Name on Card
Card Number
Expiration Date Month (MM) Year (YY)
Sponsor Information 
Name
E-Mail
Address
Address
Apartment #
City  State Zip Code
 Home Telephone
(optional) 		      
 Work Telephone
(optional) 		      
 Cell Phone
(optional) 		      
Automatically bill my credit card each month

If you prefer to pay by check or money order, CLICK HERE

Comments (if any):