
Humane Society of Blooming Grove P.O. Box 226 Washingtonville, NY. 10992
Calendar information
and request. Please submit this page to the Blooming Grove Humane Society. Remember dates and month top
pages are on a fist come, first serve basis. Please include a picture of your pet and a check or money
order payable to Blooming Grove Humane Society.
ALL PHOTOS MUST BE IN DIGITAL FORMAT OR PRINT.
NO PAPER COPIES WILL BE EXCEPTED.
First Date choice_________________________________
Second date choice in case first is taken_______________
Pets Name_____________________________________
Date If placing your pets picture on a day of the year_______
$20.00 first date, $10.00
each additional date.
Month if placing your pets picture at top of month__________ $75.00
for top page
Amount Enclosed $__________________
Name and Address________________________________
_______________________________________________
Contact Phone number(s)___________________________
Thank you for your Support!!
|

Print this form using your Browser Print Option

|