Companion Animal Donation Form, WSU College of Veterinary Medicine
  Please complete this form, print and mail to:

Pet Memorial Program
Office of Veterinary Development and External Relations
College of Veterinary Medicine
Washington State University
Pullman, WA, 99164-7010

January 09, 2009

Please direct this contribution toward:

Where need is the greatest
Veterinary Medical Education or Research
Pet Loss Hotline

The enclosed check for $ is given as a memorial gift for the following pet(s) 

Please acknowledge these gifts in my name.

Name

Veterinary Hospital (optional)

Address

City

State

Zip   

Phone

Email

Type of Pet
Name of Pet
Name & address of person to send acknowledgement to.
Please indicate if the person is a Mr., Mrs., Ms., etc.