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Tribute Information Form

Your Information
Please enter the following information about yourself

First Name: Last Name:

Business Name:

Address

City: ST ZIP:

Day Phone: Evening Phone:

email (for your receipt)

Donation Amount

Please select the amount of the donation you would like to make.

$25 $50 $100 $250 $500 $1,000
More

In Tribute To

Your donation will be made in tribute of the person you specify below:

Please select a tribute that best applies:

	In honor of a new promotion		In honor of a birthday		In honor of a graduation
	In honor of a retirement		In honor of a birth of a child		In honor of an anniversary
	In honor of a wedding		In honor of an engagement		For a speedy recovery
	For a holiday commemoration		For a successful surgery		Other (please list below)
	To honor your special friend or loved one's LOVE for ANIMALS

Acknowledgement

The Atlanta Animal Alliance, Inc. will send a special animal tribute card acknowledging your donation to the person of your choice. Enter the recipient's name and address. You can also write a personal message.

Acknowledgment card will be sent to:

Title: First Name: Last Name:

Business Name:

Company Address:

Home Address:

City: State: Zip:

How would you like your name to appear on the acknowledgement card?

From:
Title First Name Middle Last Name

Personal Message (100 words or less) :

Click the Submit Button to send your memorial/tribute information to the Atlanta Animal Alliance. Then click the donate button to process your donation. Thank You.

Copyright 2005 Atlanta Animal Alliance, Inc., All rights reserved