HRC FOUNDATION, INC.

Memorial / Honor Program - CONTRIBUTION FORM

Your contribution is tax deductible

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CONTRIBUTOR'S NAME: _____________________________________________________________

ADDRESS: ___________________________________________________________________________

CITY: _____________________________ STATE/PROV: ______________ ZIP __________________

Send notification of this contribution to:

NAME: ______________________________________________________________________________

ADDRESS: __________________________________________________________________________

CITY: _____________________________ STATE/PROV: ______________ ZIP _________________

IN MEMORY OF: __________________________________________________________

IN HONOR OF: ____________________________________________________________

OTHER: __________________________________________________________________

AMOUNT: $____________________ Make check payable to: HRC Foundation, Inc.

Mail to: HRC Memorial / Honor Program - P. O. Box 632, Big Spring, TX 79721

If you want this contribution designated to a specific beneficiary please provide COMPLETE information, including address, below. If no designee is desired, the contribution will go to the HRC Foundation, Inc., fund to support it's grants to canine medical research programs at various Universities and Colleges in addition to awarding annual educational scholarships to HRC members or their dependents.

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Thank you for your generosity and thoughtfulness. This contribution will be reported in the next issue of the HUNTING RETRIEVER Magazine, on the HRC Web-site and will become a part of the permanent record of the HRC Memorial / Honor Program - the HRC Green Book which is proudly displayed at national HRC events.