Oregon Humane Society

2013 Diamond Collar Hero Form

1. Required fields are marked with an asterisk*.

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Name:

 

 

   

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City/State/ZIP:

 

    

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What's this?

*2.
Question - Required - Are you nominating an animal or a human?


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(Maximum response 255 chars, approx. 5 rows of text)

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*7.
Question - Required - Type of animal:







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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

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(Maximum response 255 chars, approx. 5 rows of text)

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*18.

   Please leave this field empty

     


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Shelter location: 1067 NE Columbia Blvd. Portland, OR • Directions • (503) 285-7722 • Contact Us