I wish to contribute to the ASSA Foundation for the purpose (s) indicated:

HEALTH RESEARCH....................................................................  $                     

HEALTH RESEARCH - DM..........................................................  $                     

RESCUE OPERATIONS................................................................  $                     

SCHOLARSHIP PROGRAMS.......................................................  $                     

CANINE LEGISLATIVE SUPPORT..............................................  $                     

GENERAL FUND...........................................................................  $                     

                                                        Total Enclosed:  $                                               

Name:                                                                                                                         

Address:                                                                                                                     

Phone:                                                        E-mail:                                                       

Please make checks payable to ASSA Foundation, Inc.

Send to: Al Bianchi, 500 Millstone Road, Chesapeake, VA , 23322-436

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The ASSA Foundation, Inc. is a not-for-profit tax-exempt charitable organization.
Your donation to the Foundation is fully tax-deductible. Your check is your receipt.
Please retain this lower portion for your records.

Date:                              Check#:                               Amount:                               

                                            THANK YOU!