AAVA Pet Memorial Fund Donation Form

Please accept my contribution of $                             in memory of:

Pet’s Name                                                 

Species                                             

Sex                                 Breed                            

Owner’s Name                                                     

Address                                                     

City, State, Zip                                             

If donor is someone other than the pet owner:

Donor's Name                                                     

Donor's Address                                                     

Donor's City, State, Zip                                                     


Please mail this completed form with your contribution to:
The American Academy of Veterinary Acupuncture
PO Box 1058, Glastonbury, CT 06033

Our animal companions never
really leave. They continue to
live on in the wonderful memories
of the love and devotion
they naturally gave us.
With our sincerest sympathy in
the loss of your beloved pet.