Please print the form below and mail with your check or money order to:

National Brittany Rescue and Adoption Network
P.O. Box 5046
Greensburg, PA 15601-5058


Name _____________________________________________________
Street Address or P.O. Box Number _____________________________________________________
City _____________________________________________________
State & Zip Code _____________________________________________________
Phone Number _____________________________________________________
E-mail Address _____________________________________________________
Your donation will go into our General Fund unless you check one of the following options:
  My donation should be used as follows:

   Senior Dog Fund
   Special Needs Fund
   I want to sponsor ___________________________
   Specific State _______________________________

My donation is in memory of _________________________________________________