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DONOR FORM
(PRINT OUT FORM AND COMPLETE)

Supporting  $ 25 - 49  ____ Benefactor  $ 100 - 499  ____
Sustaining   $ 50 - 99  ____ Patron         $ 500 - 999  ____
Sponsor $ 1,000 and over  ____ Other                           $  ____
Non Cash Donation__________________Value $ _________

NAME_____________________________________________________________

ADDRESS__________________________________________________________

CITY___________________________________STATE________ZIP__________

IN MEMORY OF___________________________________________________

IN HONOR OF_____________________________________________________

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

to be sent:__________________________________________________________

___________________________________________________________________

              
                      

PRINT OUT FORM, FILL IN INFORMATION & MAIL WITH CHECK TO:
   Contact Us


Great Dane Health Foundation of America, Inc.
Sandra C. Lady, Treasurer
49 Distan Court
Keswick, VA  22947
(434) 295-3334
Current:  July 2005
                 
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The Great Dane Health Foundation of America Inc. is a 501(c)3  tax exempt organization.