Please print and complete this donation form and send it with your donation to SCAK at the address below.

*NO DONATION TOO LARGE OR TOO SMALL*

Yes! I would like to support the Sickle Cell Association of Kentuckiana, Inc.

xxxxxPlease make your tax deductible donations to:

xxxxxxSCAK xxxxx201 East Jefferson Street Ste. 120 xxxxxLouisville, KY 40202

Please make your check or money order payable to Sickle Cell Association of Kentuckiana, Inc.

xxxxxName
xxxxx________________________________________________________________________

xxxxxAddress
xxxxx________________________________________________________________________

xxxxxCity ___________________________________

xxxxxState _____________________ Zip ________________

xxxxxPhone # ________________________

xxxxx___$25___$50___$100 ___$Other

Thanks For Helping Us Make A Difference!