Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastDepartment *I work at *Lexington ClinicDAKMCCLCPAABest Daytime Phone Number *How many children do you/your group or department want to support with our LC Gives Program? *Please specify any age/gender/sibling preference you may have for children 0-12 years.Designate the county you would like to support *FayetteJessamineMadisonScottSubmit