Name________________________________________________
Address____________________________________________
Phone_______________________________________________
Email_______________________________________________
Pet's Name _____________ Type of animal ___________
Age__________ Sex_________ Spayed/Neutered? __________
Level of Funding Received_______________________________
Total Cost of Treatment_________________________________
Referring Veterinarian ________________________________________
Name of Clinic ________________________________________
Please
tell us your pet's story and how The Bearen Foundation was able
to help.
Occasionally we publish these stories on
our website.
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
________________________________________________________
Please
include a photo if possible. Photos will not be returned unless you provide self-addressed, postage-paid return envelope. You
may also send color copies or email photos to helpingpets@bearenfoundation.org.
In
many cases, recipients have donated time, money or skills in return
for funding. Please help us continue to help others. Contact us
at: (541) 242-3827 or send us an email! You may also check our
website for updated event information: www.bearenfoundation.org.
Signature
of Recipient:________________________________ Date:____________
Please
return this form to:
The Bearen Foundation
PO Box 10375, Eugene, OR 97440
MessageLine: 541-242-3827 Please allow 3 days for a response.
FaxLine: 541-338-2986
