DPCA Donation Form

Name:   ________________________________________

Address:________________________________________

City: State/Province:____________________________

Country/Zip/Postal Code:_______________________

E-mail address: _______________________________

Donation:

Please make checks payable to DPCA

Payment must be made in US Funds and drawn on a US bank. There will be a $25.00 service charge for any check not honored by the bank. 

Mail donation form with check or money order to:

Julie Stade,
12416 S Haven Rd
Haven, KS 67543  USA