First Name: *
Last Name: *
Card Type: *	Please select Visa MasterCard Discover American Express
Card Number: *
Expiration Date: *	01 02 03 04 05 06 07 08 09 10 11 12 2013 2014 2015 2016 2017 2018 2019 2020
Card Verification Number: *	What is this
Billing Address
Address 1: *
Address 2:
City: *
State: *	Please select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AA AE AP AS FM GU MH MP PR PW VI
ZIP Code: *
Country:	United States
Email:*
Phone:*

Thank you for your donation. When you click "Continue" you will be redirected to PayPal to process your payment.

Please Apply My Gift:
First Name: *
Last Name: *
Billing Address
Address 1: *
Address 2:
City: *
State: *	Please select AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AA AE AP AS FM GU MH MP PR PW VI
ZIP Code:*
Country:	United States
Email:*
Phone:*

If you would like to make your donation by check, please make your check payable to the Shelby Kennedy Foundation and send it to:

Shelby Kennedy Foundation
930 Prairie Avenue
Wilmington, Ohio 45177