I Want to Help

Print this page and send the completed form to the address below.

Name:_____________________________________________________

Address:____________________________________________________

Address:____________________________________________________

City:_______________________________________________________

State:____________ Zip______________________________________

Phone:_____________________________________________________

E-mail:_____________________________________________________

Please check all boxes that apply:

r     Enclosed is my tax deductible donation of $___________ (please make checks payable to ADC/PAWS)

r     Please charge my   ¨ Visa   ¨ MC

In the amount of: $_______________

Acct #: ________________________

Exp Date: ______________________

Signature: ______________________

r     I would like to volunteer – please contact me with more information

r     Please contact me concerning a bequest to PAWS in my will

r     Please accept my gift of $__________

in memory of:____________________                                      

Send acknowledgement of gift to:

_______________________________

_______________________________

   Please mail to:

PAWS c/o

The Albany Damien Center

12 South Lake Avenue

Albany, NY 12203