Yes! I want to help Kentuckiana Children’s Center.
Please print this form and mail it with your check to this address:

Kentuckiana Children’s Center
1810 Brownsboro Road
Louisville, KY 40206

Our Vision: Healing all Children…Hope for the Whole Child

Our Mission: To improve the lives of Children by providing a foundation for healing through integrative Chiropractic care.

Enclosed is my gift of:

$5000 Golden Light of Hope Leadership
$2500 Guardian of Hope Leadership
$1000 Heart of Hope Leadership
$500 Light of Hope

Other Gift (specify amount below): 

Payment Method

Check/money order enclosed for full amount

Payment enclosed, please bill me for the balance
Monthly Quarterly Annually

Please bill my credit card
Monthly Quarterly Annually

Your name:

Visa Mastercard American Express

Your card number & expiration date:
Month Year

IMPORTANT: Because we appreciate our donors, we sometimes recognize them in a public listing (such as our newsletter).
Please check this box if you would prefer to remain anonymous.


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