Memorial &

Honorarium Form

If there is a special animal or person you would like to honor, consider a gift in their name to Collie Rescue, Inc’s Memorial Gift Program. Your donation will help us to provide health care, food, and homes for collies in need and it is tax deductible.

Collie Rescue, Inc. will promptly send a personalized letter to the person or family indicated, notifying them of your thoughtful donation. And, we will also send you a notification that the letter was sent with your tax deductible receipt.

Please provide us with the following information:

This gift is being made:

in memory or in honor of

name

Please indicate if the above named honoree is a:

Dog (Breed: ) Person Other:

Please notify the following person(s) of this gift:

name

address

city state zip

This gift is being given by:

name

address

city state zip

phone email

Gift Amount: $ Enclosed is my check made payable to Collie Rescue, Inc.

Please add me to the CRI e-mail / mail list.

Mail form to: Collie Rescue Inc., P.O. Box 221982, Chantilly, VA 20153.

Thank you!