What is the occasion you are using the Honor and Remember Program for? (Please cirlce)
Birthday Get Well Congratulations In memory of deceased family member, friend or pet
Other ___________________
Did you download a card or certificate to send to the recipient? _____Yes _____No
ABOUT YOU...
Your Name ________________________________________________________
Your Address
Street ______________________________________________________
Town _________________________ State _____ Zipcode __________
ABOUT THE PERSON OR PET BEING HONORED OR REMEMBERED...
Name of person or pet being honored or remembered ___________________________________________
Is this a person or a pet? Type of pet __________
Name of person who should receive the acknowledgement ______________________________________
Address of person receiving the acknowledgement
Street ______________________________________________________
Town _________________________ State _____ Zipcode __________
Do you wish the recipient be told of the amount of your gift? _____Yes _____No
When we receive this application and your check we will notify the person you have designated about your unique gift and how it will help RPC. We will also send you an acknowledgement of your tax-deductable donation.
Enclosed is my check for $______ payable to "Responsible Pet Care"
Responsible Pet Care
P.O. Box 82
Norway, Maine 04268