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2 letter abbreviation
Spouse_Partner First Name
Spouse_Partner Last Name
Earmark Your Donation
Christmas Campaign - Jan Flagg Fund
Special Needs Springer
Charlotte's Senior Fund
The Jan Flagg Memorial Fund
Other (please specify below)
Addt'l earmark details
2018_Strut Your Mutt
Special Needs Springers
All Special Needs Springers (This donation will not be posted to any web page.)
Select one, if your donation is for a Special Needs Springer.
Note: Any funds raised in excess of this dog's need may be applied to another needy dog without restriction
Dog Name / Intake Number
To earmark a donation for a specific dog, that is not listed as a Special Needs Springer, please provide the name & the intake number (if known).
Other reason (please specify)
Memorial or Tribute Instructions
Please include details associated with memorial or honorary donations, including those ESRA should notify of the donation.
ALL Donations - permission to post on website
I give permission for my name to be posted on the website as a donor. (Amount is never publicized.)
I prefer that my donation and name remain private, not publicized on the website.