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This is for submission to the mailing list and newsletter. Please make sure you spell the name correctly and have the exact address. Only names of adopters, donors and seriously interested parties are to be added. When filling out this form, if you accidently "send" it before completing it, you can use your "back" key to go back and continue filling out the information. All fields need to be filled out in order to get the name of the person on the mailing list.  |
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Todays Date:
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CCDR Representative
who is adding this name:
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CCDR Representative's
email address:
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Please choose which
applies:
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Name of person to
put on mailing list:
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Their Address:
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Apt. #
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City:
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State:
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Zip:
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Phone:
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The person's E-mail
address:
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