KHA-PAC Contribution Form

Your contribution is important to us, but we want to emphasize that all contributions are voluntary and have no impact on your job status, performance review, compensation or employment. Any amount given or the decision not to give will not advantage or disadvantage you. Contributions or gifts to KHA-PAC are NOT deductible as charitable contributions for federal income tax purposes. Information below is required by state and federal campaign finance laws. 

First Name *
Last Name *
Hospital/Organization *