CEF of Kansas Website Donation Form

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Legal First Name (Not Nickname) *

Please enter ONLY 1 first name

Last Name *

Preferred Name (Nick Name)

Optional

Prefix

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Suffix

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Address Line 1 *

Please use abbreviations for St, Rd, Ln, Dr, Hwy, Ave, N, S, SE, SW etc. Do not use commas, periods or colons excepting P.O. Box use periods.

Address Line 2 (Optional)

Optional field.Please use abbreviations for St, Rd, Ln, Dr, Hwy, Ave, N, S, SE, SW etc. Do not use commas, periods or colons excepting P.O. Box use periods.

City *

State/Province *

Zip/Postal Code *

Submit as a company

Company Name

Are you part of a specific chapter or the state? *

State of Kansas

Southeast Kansas Chapter

Email *

Data Privacy & Consent

Yes, I would like to receive communications from CEF of Kansas by email.

Yes, I would like to receive communications from CEF of Kansas by mail.

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Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

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Address Line 1

Address Line 2

City

State/Province

Zip *

Country

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