Dalmatian Club of America Foundation, Inc.

Indicate amount enclosed:

__ $50 Supporter      __ $100 Donor      __ $250 Grand Donor      __ $600 Patron

__ $1000 Grand Patron     __ $5000 Benefactor      __ $10,000 Grand Benefactor

__ Other Amount $____________________

Person(s) making contribution: _________________________________________________________________

Address:
_________________________________________________________________

_________________________________________________________________

Email Address:
_________________________________________________________________

Phone:
_________________________________________________________________

In honor of:
_________________________________________________________________

In memory of:
_________________________________________________________________

Name and address of person to whom acknowledgement of honor or memorial

is to be sent:
_________________________________________________________________

__________________________________________________________________

YOU CAN USE YOUR VISA FOR YOUR TAX DEDUCTABLE DONATION:

Card # _______________________               Expirey Date: ________

Full name on card ___________________       Amount $ __________

Signature ___________________________________

1) Click on Printer icon to print out this page:

2) Fill out the form.

3) Mail to:
Sheila Wymore
PO Box 268
Cornville AZ   86325


Email Sheila


Return to the Home Page

Copyright © 2002 - 2013
DALMATIAN CLUB OF AMERICA FOUNDATION, INC.
All Rights Reserved

Please submit comments, requests and suggestions to
Direct to the Foundation