Easy  Donor
Coupon

Deadline
Dec 31
 

Name:_______________________________________

Address:_____________________________________

            _____________________________________

Amount:_______________  
 
Date:________________

e-mail address so we can acknowledge that we received your check.

_____________________________________

This money is to be used specifically for Dr. Acland's research into Glen of Imaal Terrier PRA.

Signed:__________________________

Make your check payable to:

James A. Baker Institute at Cornell University

Your entire donation is tax deductible.

 
Mail your check and this coupon to:

Kathy Georgianna 
1070 B West Road
Williamsburg, MA 01906   USA

or

Les Anthony, Treasurer
Glen of Imaal Terrier Club of America
8 Nutmeg Court
Wallingford, CT 06492