Parkinson Support Center of Kentuckiana

Donation Form

We appreciate your support of our programs and services. Your generosity will be recognized on our supporters' page, as well as with a personal thank you for your tax-deductible gift. Together, we are making a difference in the lives of people living with Parkinson's disease.

(*) Field Required

Personal Information

*First Name:

*Last Name:

*Address:

Apt/Suite:

*City:

*State:

*Zip:

Phone:

*Email Address:

Please type donor name as you wish for it to appear in print:

Gift Information

I would like to make this donation:

	In celebration or honor of
	In memory of

Name:

Please notify this person that I have made a donation
(Note: We will not share the amount of your gift)

Name:

Address:

Apt/Suite:

City:

State:

Zip:

Gift Amount:

	$1,000
	$500
	$250
	$100
	$50
	$25
	Other

Matching Gift Information

Many companies will match your gift to PSCKY. Your employer's Human Resources department should be able to answer your questions about your company's matching gift program and provide you with a matching gift form.

Stay Informed

	Yes, I'd like to receive the weekly PSCKY e-newsletter
	Yes, I'd like to receive occasional information by mail about PSCKY's work

Tell Us About Yourself:

	I am someone with Parkinson's disease
	I am a care partner or family member of someone with Parkinson's disease
	Other:

Payment:

78860 (insert codes below)

Security Code:

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