Honor a Nurse ~ Remember a Nurse

Honor a Nurse ~ Remember a Nurse
This form is for if you wish to make a one time donation to honor or remember nurses.

If you would like to donate to the Kentucky Nurses Foundation, but would not like to specify who the donation is for, please scroll to the bottom and click "Next." There you can fill out a simple donation sheet.

Click here if you wish to make a recurring donation, instead.
Only credit cards are accepted online!

If you are paying with check, please make checks payable to KNF- Kentucky Nurses Foundation. Please print out your completed form and mail it with your payment to: KNA Office - 305 Townepark Circle, Suite 100, Louisville, KY 40243.
You can honor or remember up to 10 nurses each!
The Kentucky Nurses Foundation (KNF), established in 1975 as a 501 (c)(3) status foundation, has both a contractual and professional relationship with the Kentucky Nurses Association to enhance achievement of the strategic goals of both organizations. The Kentucky Nurses Foundation has a long history of supporting nursing scholarship and research. The mission of the Kentucky Nurses Foundation is to promote the highest level of health for the citizens of the Commonwealth of Kentucky by advancing the practice of nursing through nursing scholarship and healthcare research.
This gift is tax-deductible. The Kentucky Nurses Foundation is a 501(c) (3) organization. Federal tax ID# 31-0915644
Date

MonthDayYear
Date
Would you like to HONOR or REMEMBER up to 10 nurses? You can also do BOTH!
Honoring up to 10 nurses!
Honoree #1 Name

First NameLast Name
Honoree #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #1 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #1
How much would you like to donate in contribution to Honoree #1? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #1?
Add a second nurse to honor?
Honoree #2 Name

First NameLast Name
Honoree #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #2 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #2
How much would you like to donate in contribution to Honoree #2? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #2?
Add a third nurse to honor?
Honoree #3 Name

First NameLast Name
Honoree #3 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #3 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #3
How much would you like to donate in contribution to Honoree #3? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #3?
Add a fourth nurse to honor?
Honoree #4 Name

First NameLast Name
Honoree #4 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #4 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #4
How much would you like to donate in contribution to Honoree #4? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #4?
Add a fifth nurse to honor?
Honoree #5 Name

First NameLast Name
Honoree #5 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #5 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #5
How much would you like to donate in contribution to Honoree #5? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #5?
Add a sixth nurse to honor?
Honoree #6 Name

First NameLast Name
Honoree #6 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #6 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #6
How much would you like to donate in contribution to Honoree #6? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #6?
Add a seventh nurse to honor?
Honoree #7 Name

First NameLast Name
Honoree #7 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #7 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #7
How much would you like to donate in contribution to Honoree #7? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #7?
Add an eighth nurse to honor?
Honoree #8 Name

First NameLast Name
Honoree #8 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #8 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #8
How much would you like to donate in contribution to Honoree #8? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #8?
Add a ninth nurse to honor?
Honoree #9 Name

First NameLast Name
Honoree #9 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #9 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #9
How much would you like to donate in contribution to Honoree #9? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #9?
Add a tenth nurse to honor?
Honoree #10 Name

First NameLast Name
Honoree #10 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Honoree #10 Email Address
example@example.com
Gift is in honor of (i.e.: years of service, birthday, graduation, etc.) for Honoree #10
How much would you like to donate in contribution to Honoree #10? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Honoree #10?
Name
Donor Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number

Area CodePhone Number
Email
example@example.com
Remembering up to 10 nurses!
Name of Nurse Remembered #1

First NameLast Name
Date of Death (if known) for Nurse Remembered #1

MonthDayYear
Date
Nurse Remembered #1's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #1?
Please include the contact information of the Nurse Remembered #1's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #1's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #1's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #1
How much would you like to donate in contribution to Nurse Remembered #1? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #1?
Add a second nurse to remember?
Name of Nurse Remembered #2

First NameLast Name
Date of Death (if known) for Nurse Remembered #2

MonthDayYear
Date
Nurse Remembered #2's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #2?
Please include the contact information of the Nurse Remembered #2's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #2's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #2's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #2
How much would you like to donate in contribution to Nurse Remembered #2? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #2?
Add a third nurse to remember?
Name of Nurse Remembered #3

First NameLast Name
Date of Death (if known) for Nurse Remembered #3

MonthDayYear
Date
Nurse Remembered #3's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #3?
Please include the contact information of the Nurse Remembered #3's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #3's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #3's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #3
How much would you like to donate in contribution to Nurse Remembered #3? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #3?
Add a fourth nurse to remember?
Name of Nurse Remembered #4

First NameLast Name
Date of Death (if known) for Nurse Remembered #4

MonthDayYear
Date
Nurse Remembered #4's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #4?
Please include the contact information of the Nurse Remembered #4's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #4's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #4's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #4
How much would you like to donate in contribution to Nurse Remembered #4? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #4?
Add a fifth nurse to remember?
Name of Nurse Remembered #5

First NameLast Name
Date of Death (if known) for Nurse Remembered #5

MonthDayYear
Date
Nurse Remembered #5's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #5?
Please include the contact information of the Nurse Remembered #5's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #5's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #5's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #5
How much would you like to donate in contribution to Nurse Remembered #5? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #5?
Add a sixth nurse to remember?
Name of Nurse Remembered #6

First NameLast Name
Date of Death (if known) for Nurse Remembered #6

MonthDayYear
Date
Nurse Remembered #6's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #6?
Please include the contact information of the Nurse Remembered #6's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #6's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #6's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #6
How much would you like to donate in contribution to Nurse Remembered #6? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #6?
Add a seventh nurse to remember?
Name of Nurse Remembered #7

First NameLast Name
Date of Death (if known) for Nurse Remembered #7

MonthDayYear
Date
Nurse Remembered #7's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #7?
Please include the contact information of the Nurse Remembered #7's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #7's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #7's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #7
How much would you like to donate in contribution to Nurse Remembered #7? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #7?
Add an eighth nurse to remember?
Name of Nurse Remembered #8

First NameLast Name
Date of Death (if known) for Nurse Remembered #8

MonthDayYear
Date
Nurse Remembered #8's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #8?
Please include the contact information of the Nurse Remembered #8's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #8's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #8's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #8
How much would you like to donate in contribution to Nurse Remembered #8? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #8?
Add a ninth nurse to remember?
Name of Nurse Remembered #9

First NameLast Name
Date of Death (if known) for Nurse Remembered #9

MonthDayYear
Date
Nurse Remembered #9's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #9?
Please include the contact information of the Nurse Remembered #9's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #9's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #9's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #9
How much would you like to donate in contribution to Nurse Remembered #9? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #9?
Add a tenth nurse to remember?
Name of Nurse Remembered #10

First NameLast Name
Date of Death (if known) for Nurse Remembered #10

MonthDayYear
Date
Nurse Remembered #10's Years of Service as a Nurse
Has the family requested a Nightingale Service for Nurse Remembered #10?
Please include the contact information of the Nurse Remembered #10's family member or friend for the acknowledgment letter.

First NameLast Name
Nurse Remembered #10's Family Member or Friend's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nurse Remembered #10's Family Member or Friend's Email Address
example@example.com
Family Member or Friend's Relation to Nurse Remembered #10
How much would you like to donate in contribution to Nurse Remembered #10? Please type in a dollar amount and please do not type in "$."
USD
Old - How much would you like to donate in contribution to Nurse Remembered #10?
Years of service as a nurse (if known)

Donor Information
Donor's Name

First NameLast Name
Donor's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Donor's Preferred Phone Number

Area CodePhone Number
Donor's Email Address
example@example.com
If you are paying by check, please do not click submit! Please make checks payable to KNF- Kentucky Nurses Foundation. Print out your completed form and mail it with your payment to: KNA Office - 305 Townepark Circle, Suite 100, Louisville, KY 40243.
Add any additional comments you have here:
Please write checks out to Kentucky Nurses Foundation.

If you are paying with check, do not click submit! Rather, completely fill out the form, then print it out and mail it, along with your check to:

KNA Office

305 Townepark Circle

Suite 100

Louisville, KY 40243
Please Input Your Total Donation
USD

Total - Do Not Input Anything into this Box - Please Insert Your Donation in the Box Above

USDRead-Only

Credit Card

Please only click "Submit" once to avoid being charged multiple times.
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Honor a Nurse ~ Remember a Nurse

Only credit cards are accepted online!

You can honor or remember up to 10 nurses each!

This gift is tax-deductible. The Kentucky Nurses Foundation is a 501(c) (3) organization. Federal tax ID# 31-0915644

Honoring up to 10 nurses!

Remembering up to 10 nurses!

Donor Information

If you are paying by check, please do not click submit! Please make checks payable to KNF- Kentucky Nurses Foundation. Print out your completed form and mail it with your payment to: KNA Office - 305 Townepark Circle, Suite 100, Louisville, KY 40243.

Total - Do Not Input Anything into this Box - Please Insert Your Donation in the Box Above *

Credit Card

Total - Do Not Input Anything into this Box - Please Insert Your Donation in the Box Above