Yes, I would like to help low-income pet owners.
Enclosed is my tax deductible gift to support the RIVMA Companion Animal Foundation.

___$25 ____ $50 ____$75 ___$100 Other $____

Your name:_______________________________________________
Address: _________________________________________________
City: _______________________________State:____ Zip:_________

This gift is in honor of: _____________________________________
This gift is in memory of: ___________________________________

Please send acknowledgement to:

Name: ___________________________________________________
Address:__________________________________________________
City: _____________________________State: ____Zip: ___________

Please make checks payable to: RIVMA Companion Animal Foundation, 11 South Angell Street, #311, Providence, RI 02906

Credit Card Information
Please circle one: Mastercard Visa American Express
Amount: _______________
Credit Card Number: _______________________________________
Exp. Date: _____________________

Signature ________________________________________________