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Donation made in appreciation |
| or
Donation made in memory of: (Pet's name) ...................................................... |
| Breed
........................................................................................... Age
............... |
| Owner's
name ................................................................................................................ |
| Address
.........................................................................................................................
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| ...............................................................................................
Ph: ( ) ........................ |
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I wish to support The NZ Companion Animal Health Foundation
and its objective of improving the general health and
well-being of our companion animals.
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My
cheque for $ ............... is enclosed.
or |
(please make cheque payable to
The NZ Companion Health Foundation) |
| please
accept my contribution of $ ................ and
charge to my credit card (details below) |
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Visa |
Mastercard |
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| Card
account number |
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Name
on card |
Expiry
date |
Signature |
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| Please
tick if a receipt is required to be sent to the
address you have shown above. |
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I prefer that my donation be used in the following
area/s: |
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Area
of greatest need |
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Canine
(dog) problems |
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Feline
(cat) problems |
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Bird
problems |
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Heart
disease investigations |
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Cancer
investigations |
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Caged
pet (Rabbits, Guinea pigs etc) problems |
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Animal
behaviour /human-companion bond studies |
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The information that you supply will be kept in
accordance with the provisions of the Privacy Act.
It will not be supplied to any other party without
your express consent. |
Please tick if you do not wish to receive
further information from the Foundation.
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PLEASE POST OR FAX TO:
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The
NZ Companion Animal Health Foundation
c/- The New Zealand Veterinary Association |
PO
Box 11-212
Manners Street
Wellington |
Ph:
(04) 471 0484
Fax: (04) 471 0494
http://www.healthypets.org.nz |
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