Protectors Of Animals Donation Form

Please enter your information and print this page.
Make your check payable to POA, and mail both
the form and the check to:

 POA
P.O. Box 24
South Glastonbury, CT 06073
Payment
Information		  

Check One:
 Membership 
Gift Membership
Memorial Donation
General Donation

Enclosed is:
 $25 Individual Membership
$35 Family Membership
$50
$100
Other

Date:

Receipt Required?
Yes    No 

Check #
(Checks payable to POA)
Your
Information		   Name:
    Address:
    City: State: Zip:
    Phone:
    Email:
    Credit Card #:
(MC or Visa)

Exp. Date:
    Signature:
Gift
Membership		   Name:
    Address:
    City: State: Zip:
    Phone:
Memorial
Information		   In Memory Of:
    By:
 

We at POA Thank You for your Generosity.