Please
feel free to read over our Privacy
Policy and Security
Statement
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Please do not use quotation marks anywhere in this form, as it will cause subsequent data to be lost.
Your Name:
Address:
City
State
Zip
Phone :
E-mail :
Please
check this box if you wish to be listed as an "Anonymous Angel":
Amount of Donation:
Please designate as 0.00
(do not type a $ symbol)
In memory of:
(Please do NOT use quotation marks)
(Optional - donate a
memorial tribute in memory of a dog or a person)
This donation to 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:
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.
Any Springer in need
Comments:
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quotation marks!
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Again, our thanks for choosing to help Springer Spaniels in need!
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