Please fill out the information requested below. This form may be filled out online and submitted to CHILD by clicking one of the PAY ONLINE buttons. This will also take you to a secure PayPal form.  You don’t have to have a PayPal account, although you can create one if you wish.  PayPal honors Visa, Mastercard, Discover, or American Express.

If you prefer not to pay online, you can print this filled-out form by clicking the PRINT & MAIL button at the bottom. Then mail it along with a check to the address indicated there.

The only requirement for membership in CHILD Inc. is general agreement with its aims. By submitting this form and paying your first year’s dues, you are indicating your agreement.  All information will be held strictly confidential and used only for CHILD’s administrative purposes.

Minimum annual dues are as follows:

Individual/family - $40  Full-time student - $15  **Gift Membership - $15  Other   $ 

New member  (Please fill out the form below.)

Renewing member  (Please enter your name and email and any changes in your contact info in the form below.)

(Please wait to be taken to the PayPal page and re-enter your total contribution there.)

How would you like to receive the newsletter?

Donating without becoming a member:

$15    $25    $50    $100    $200    $500    Other     $

Your Name (required field)


City, State, Zip

Phone number(s)

Email (required field)

Training, vocation, community service or special interests you may have in children’s welfare or any other note you would like to make.

**If this is a Gift Membership, please give contact information for the recipient below. The
donor’s info should go above.



Phone number(s)


All dues and donations are tax-exempt.

(Please wait to be taken to the PayPal page and re-enter your total contribution there.)

to: Children’s Healthcare Is a Legal Duty, 136 Blue Heron Place, Lexington, KY 40511

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