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Thank you for your support. If you wish to make a pledge to support KCHS, please complete the form below. Based on the information you provide, KCHS will send you an invoice for your pledge, where you will be able to pay for your pledge by check, credit card, or stock transfer. If you prefer to make a secure online donation using your credit card, you may click on the DONATE button in the menu to the right to send your donation through Paypal.
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An asterisk (*) indicates a required field |
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Title |
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*First Name: |
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*Last Name: |
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*Home Address 1: |
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Home Address 2: |
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*City: |
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*State/Province: |
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Country: |
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*Zip or Postal Code: |
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*Phone (Home): |
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Phone (Work): |
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Phone (Mobile): |
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Primary Affiliation: |
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Class of:
(If applicable) |
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GIFT DETAILS |
*Gift Amount: |
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*This is a: |
New Commitment
Payment on an Existing Pledge |
*Gift Purpose: |
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If other, please describe: |
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Dedication: |
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Name:
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Notify the following of my gift dedication: |
Name: |
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Address: |
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City, State: |
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Zip:
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METHOD OF PAYMENT (Choose One) |
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Please Bill Me (Option 1) |
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Note: Annual Fund pledges must be paid in the fiscal year (July 1 - June 30) in which pledged.
You will receive a billing statement in the mail within the next two weeks.
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Stock Transfer (Option 2) |
Details: |
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Matching Gift: |
Yes
No |
Company: |
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If applicable, please fax matching gift forms to the KCHS Development Office at 865/560-0314 |
Recognition: |
I (We) wish to remain anonymous. |
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Please recognize me/us in KCHS publications in the following way: |
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Please type your name(s) as you would like it to appear in a KCHS publication. |
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