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Veterinary Honor Roll Nomination Form

Enclosed is my gift:
$250.00 for Honoree's name only _________
$500.00 for Honoree's name and picture _________
Please make check payable to the MVMF and note the donation is for the Veterinary Honor Roll or by Mastercard or Visa #________________________ Exp.: __________
Name:
Address:
City:
State:Zip Code:
Phone:
Recipient's Information
Honoree's Name:
( )Living ( )Deceased
Relative to be notified:
Address:
City:
State:Zip Code:
Electing outstanding veterinarians to the Veterinary Honor Roll is a special way to support the Veterinary Museum and the Missouri Veterinary Medical Foundation and show appreciation for individual veterinarians at the same time. The MVMF is a 501 (c) (3) tax exempt organization. Your donation is tax deductible to the full extent of the law.
For more information, please call:
573-636-8737



Missouri Veterinary Medical Association

2500 Country Club Drive, Jefferson City, MO 65109
Phone: 573-636-8612 Fax: 573-659-7175 Email: mvma@mvma.us

© 2001 -2010 Missouri Veterinary Medical Association and Huber & Associates, Inc.