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Every seven minutes someone in America becomes legally blind or visually impaired.

Memorial Pathway Form

An * indicates a required field.

* First Name:

* Last Name:

* Billing Address:

* Billing City:

* Billing State / Province:

* Billing Zip / Postal Code:

* Billing Country:

* Email Address:

* Billing Phone:


* Plaque Size:
 500.00 Large Plaque (12”x12”) - $500 Donation
 300.00 Small Plaque (12”x6”) - $300 Donation

* Name of honoree(s)

* Honoree(s) Address(es):

Message for engraved plaque (please limit to 15 words)


Credit Card Information

* Type of Card:

* Name on Card:

* Card Number:

* Security Code (where to look):

* Exp. Date: /

* Agreement: I agree to pay the dues I selected above, please charge my credit card.

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Please send me more information on Guide Dogs of the Desert:   


Thank you for your generous contribution.
A tax deductible letter will be sent to you.


Guide Dogs of the Desert - Taking the Time to Change Lives
Guide Dogs of the Desert - PO Box 1692 - Palm Springs CA 92263 - 760-329-6257 www.guidedogsofthedesert.org
*Puppies are evaluated at 18-22 months of age for various traits. Not all dogs will become Guide Dogs, some will have a change of Career and become an Assistance or Search and Rescue dog.
Others may be offered up for adoption.
Please keep a copy of this application as your tax deductible receipt.