PLEASE TYPE YOUR ANSWERS IN, THEN PRINT AND SIGN.
As a non-profit 501(c)(3) rescue organization, your E.P.O.N.A. sponsorship if fully tax-deductible.
STREET ADDRESS AND/OR PO BOX:
CITY, STATE, AND ZIP CODE:
HOME TELEPHONE NUMBER:
HOME E-MAIL ADDRESS:
WORK TELEPHONE NUMBER:
WORK E-MAIL ADDRESS:
RETIREE(S) YOU WISH TO SPONSOR:
PLEASE PUT AN X IN ONE OF THE FOLLOWING BOXES:
FULL SPONSORSHIP ($250.00): PARTIAL SPONSORSHIP: IF PARTIAL, PLEASE TYPE IN AMOUNT: $.00
YOUR SIGNATURE TODAY'S DATE
Please print this form, then sign and date it.
When complete, please send along with your check or money order to:
E.P.O.N.A., PO Box 315, Epping, NH 03042-0315
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