Doctor's Petition to Elected Officials

As a Kentucky Physician, I request that you nominate judges who will stop Partial Birth Abortions.***

 

Name**                        ______________________________________________

Degree**                      ______________________________________________

Speciality**                 ______________________________________________

Addess of Practice    ______________________________________________

City, State, Zip            ______________________________________________

E-mail                          ______________________________________________

Phone                          ______________________________________________

County                         ________________________________________________

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*Email address or other contact information preferred

**Indicates required information for petition to be catalogued
***See PDF file for download below