ESRA ONLINE DONATION FORM
  Thank you for choosing to donate to ESRA! Please complete the following FOR OUR RECORDS ONLY
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Your Name:
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Please check this box if you wish to be listed as an "Anonymous Angel":
Amount of Donation:
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In memory of: (Please do NOT use quotation marks)
(Optional - donate a memorial tribute in memory of a dog or a person)
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ESRA will be used
as a gift for:


(Optional - donate a gift to remember a special occasion or to honor a friend)
Please include the name & address of the recipient of your gift in their honor,
and the nature of the gift below
 


If you have designated a gift recipient above, please give a name
and address to which we will send a card informing them of your gift.
Also note any special instructions, including any deadlines.  If
notification by email is also desired, please include that, too.
Earmark this
donation for:


The Walk-a-Mile for Rescue Fundraising Campaign
For an additional $20 donation, send me a Walk-a-Mile T-shirt, too!
        (Please specify size in "Comments" box in section below)
A Special Needs dog - name:
        Note: Any funds raised in excess of this dog's needs may be applied to another needy dog without restriction.
The Jan Flagg Memorial Fund
        Note: Jan Flagg Fund monies are used as the last hope for elderly, severely ill, or severely injured Springers.
All Springers in ESRA's care.
        Note: This donation may be used to help any and all dogs within ESRA's program where needed most.
Comments:
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Again, our thanks for choosing to help Springer Spaniels in need!

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