CALIFORNIA VETERINARY MEDICAL FOUNDATION
DONATION FORM

If you would like to make a tax-deductible donation to the California Veterinary Medical Foundation, please send in your check with this form. Amount enclosed:

$ _______________

Name __________________________________________________________

Hospital Name ___________________________________________________

Address ________________________________________________________

City ________________________________ State _____ Zip ______________

Phone #________________________________

Please apply my donation to: ____ CVMF Fund ____ Disaster Fund or

____ Memorial Gift Program: In honor/memory of a special pet/person (circle one)

_______________________________ Name of person/animal (please include species)

Send acknowledgment to: ___ Mr. ___ Mr./Mrs. ___ Ms.

Name ________________________ Address ___________________________

City _________________________ State ______ Zip _______________

Please send donations to:

California Veterinary Medical Foundation
1400 River Park Drive, Suite 101
Sacramento, CA 95815

If you have any questions or comments, you can reach us at:

800/655-2862 ext 42
Fax 916/646-9156
email dcary@cvma.net