Application for  "Jeanette Schirs Recognition of Service to Animals" Award

Print out and mail completed application to

ARF Award

P.O. Box 593

Centreville, MI 49032

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PLEASE PRINT

Name of Person You Wish to Have Recognized_________________________________

Their Address_______________________________________________________

Their Phone Number  __(______)______________                   Zip______________

Your Name_______________________________________

Your Phone Number __(______)_______________

Do you want this person to know you nominated them?    ____Yes    ____No

Description of why this person should be recognized:

(use extra paper if needed)

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