Name:          

E-Mail:           

If you wish to apply your donation to a specific fund, complete the following:

     $  General Fund (any unspecified amount will be applied to this fund)

     $  Leo Fund - provides surgical care for special needs dogs.

     $  Simile-Finale Fund - provides holistic and alternative therapies (e.g., acupuncture, swim
                     therapy, etc.) for special needs dogs.

     $  Other -  

If you wish to provide a dedication, memorial or any other information about your donation,
enter it here:

Is all of the above information correct?  If so, select "Yes" here:              No Yes