1. science
2. medicine
3. surgery
4. transplants

What is KHAKY?
KHAKY’s 11th Annual
Kidney Health Alliance of Kentucky
1517 Nicholasville Road, Suite 203
Lexington, Kentucky 40503
Our Mission:
To serve kidney disease patients and their families, raise
awareness and early detection of chronic kidney disease
(CKD), provide a network for collaboration among renal
healthcare providers and promote organ donation.
Where does the money go?
For questions or more information,
please contact KHAKY:
1517 Nicholasville Road
Suite 203
Lexington, Kentucky 40503
859-277-8259
Fax: 859-277-2229
www.khaky.org
Pat Ham, Executive Director
director@khaky.org

Help KHAKY provide life sustaining nutritional
supplements (Ensure, Boost and other protein
supplements), renal vitamins and phosphorus binders for a dialysis patient at more than 30 percent
below retail cost, and in some cases, at no charge
to the patient. Over 100 cases of product are
distributed each month through dialysis clinics
across the eastern half of Kentucky.

Help cover the cost of supplies for urine screenings
for indicators of possible chronic kidney disease.
KHAKY offers free kidney health screenings to
communities through public health fairs, community
events, etc.

Help KHAKY provide emergency financial aid of up
to $200 per year per patient for assistance with
housing, medication or transportation costs.

Help KHAKY get potential transplant candidates get
qualified for acceptance on the transplant list.

Help KHAKY host an annual renal conference to
provide networking and collaboration among renal
healthcare providers.

Help KHAKY offer the O’Meara Kidney Health
Screening. This program is an employer sponsored
screening at business locations as either an
independent event or as part of an employee health
fair.

Help KHAKY work with the Donate Life Kentucky
coalition with programs that promote organ
donation. “Life is Cool” is a joint effort of coalition
members to help 4th & 5th grade students understand the organs in their body and the benefits of
healthy life choices.
Kidney Health Alliance of Kentucky (KHAKY)
Is a tax exempt 501c3 organization.
Your contribution of support is tax deductible.
TIN 23-7153964
Support—Save—Share Come
join
the fun
Help Fight Kidney Disease!
Walker Collections Form
All money collected must be turned in the day of the Walk.
Online contributions can be made at www.khaky.org as a
donation in honor of You as a walker. Only cash or check
donations turned in by you the day of the Walk should be listed on this form. Make checks
payable to KHAKY.
$
DONOR
DONOR EMAIL
DONATION
AMT
RECEIPT
PROVIDED
Register online at www.khaky.org
Make raising money easy by posting
a link to www.khaky.org on your Facebook or Twitter to share with
friends and family! Donors can make
their online donation and just
indicate it’s for you or your team
Visit www.khaky.org to sign up to participate
as an individual or pair up with co-workers,
friends and family to form a team! Collect
your own donations in person or through
your Facebook, twitter or Google + page or
via email. One hundred percent of the funds
raised for this Walk are used to support the
programs and services KHAKY provides right
here in Kentucky.
Event Details:
Date:
Saturday, April 18, 2015
Registration/Check-in:
8:30am
2k Walk Begins:
9:00am
Location:
Fayette Mall Food Court
Parking:
Food Court Entrance at Rear of Mall
Entry Fee:
Route:
Registration:
$20 per person
Family fun walk inside Fayette Mall
Register online at www.khaky.org
Walker prizes will be given to the
highest fundraising individual and team.
All registered participants* will receive a
“Thank you” goodie bag and official walk t-shirt.
Prizes:
Course is handicap/stroller
accessible and suitable for participants of all
ages. Children can accompany parents
without a registration fee.
Other information:
FREE HEALTH FAIR beginning at 9:30 for all
participants and mall guests.
* those who have completed a registration form, either at
the event or online, and turned in a minimum of $20.
Entry Form
Please complete and return to :
Kidney Health Alliance of Kentucky
1517 Nicholasville Road, Suite 203
Lexington, Kentucky 40503 or fax 859-277-2229
Register online at www.khaky.org
First Name_________________________________________
Last Name _________________________________________
Address __________________________________________
City _______________________ State ____ Zip __________
Home Phone _______________________________________
Work Phone________________________________________
E-Mail ____________________________________________
I am walking as:






Company Team
Family Team
Individual
Team Captain’s Name ________________________________
Company/Organization _______________________________
My company has a matching gift program.
Waiver: In my acceptance, I do hereby indemnify and hold harmless
the Fayette Mall Shopping Center, its owners and management, including the Lexington Joint Venture, Fayette Mall SPE, LLC, CBL & Associates Properties, Inc., CBL & Associates Management, Inc., CBL & Associates Limited Partnership, CBL Holdings I, Inc., CBL/Fayette I, LLC,
CBL/JI, LLC, Fayette Plaza CMBS, LLC, Teachers Insurance & Annuity
Association of America, Northwestern Mutual Life Insurance Company,
ERMC II, L.P., ERMC III Property Management Company, LLC and each
tenant of the Center from and against any and all claims during my time
as a participant of the Kidney Health Alliance of KY Walk with Sidney for
personal injuries, death, damages, and liability resulting from the Walk’s
activities, costs and or other expenses, including attorney’s fees, arising
from or in any way connected with the use of the Shopping Center or any
part of facilities thereof by the Walk with Sidney participant signed below,
his/her agents, members, partners, associates, contractors, servants, or
immediate family members.
Signature __________________________________________
Participant or Parent/Guardian
Walk with Sidney Participant:
Adult Shirt Size: S M L XL 2XL 3XL
Have you or your family been affected by kidney disease? Yes/No
Blank receipt forms are available at the KHAKY office or via email to director@khaky.org
Would you like to become a KHAKY volunteer? Yes/No