Please fill out the form below to make a donation to the 

Kentucky Rural Health Association Silent Auction 

To Benefit our Student Members

Warning: browser cookies disabled. Please enable them to use this website.

Donation

* Mandatory fields
*First name
Middle name
*Last name
Suffix Jr_Sr
*Organization
*e-Mail
Home Telephone
Cellular Telephone
Business Telephone
Fax
*Amount ($USD)
Address
City
State / province
Postal code
Comment

Security check

* Code
 
Type the 6 characters you see in the picture
Captcha code image
Hear the code Try another code
© Kentucky Rural Health Association  |  36 South Alvasia Street  |  Henderson KY 42420  |  (270) 577-1707  
kentuckyruralhealthassociation@gmail.com OR krha@twc.com
Powered by Wild Apricot Membership Software