English Springer Rescue America

ESRA MAIL-IN DONATION FORM

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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:	(Optional - donate a memorial tribute in memory of a dog or a person)
This is a gift for:	(Optional - donate a gift to remember a special occasion or to honor a friend)
	If you have designated a gift recipient above, please give a name and address to which we can send notice of your gift:
Earmark this donation for:	A Special Needs dog - name: The Jan Flagg Memorial Fund Any Springer in need
Comments:
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