DM Doggie Directory Form
by Michele Wisniewski
If you have more than 1 dog you would like included please fill out separate form for each.
To make corrections / updates / changes please contact me through https://www.facebook.com/DMdirectory or email me at DMdirectory@comcast.net
First Name *
Can be a single name Joe or more than one name Joe & Jill or You can also split it up like this (First Name) Joe Smith & (Last Name) Jill Jones Please enter how you would like it to appear in the directory.
Your answer
Last Name *
Your answer
Dog's Name *
Your answer
DM Doggie Directory Inclusion: *
Please select your response
Optional Questions
The questions below are strictly optional, although a picture MUST be submitted either through this form, through the DM Directory page or email to be included in the directory.
Note: If you have a picture in the original directory you do NOT need to resubmit but may if you want a different image.
Dog's Date of Departure
(if applicable)
MM
/
DD
/
YYYY
Dog's Birth Date
(optional)
MM
/
DD
/
YYYY
Short Sentiment or Special Rememberence
(optional) 250 character max
Your answer
Breed
(optional)
Your answer
Sex
(optional)
Date "Diagnosed"
(optional)
Your answer
Other comments or suggestions etc. Also please note here if your dog does not have DM but has a disorder similar to DM to raise awareness of other conditions that might present the same.
(optional)
Your answer
Link to a specific picture you would like used (Copy and paste the URL of a pic you have shared publicly or to the group)
OR You can PM the picture on the Facebook page https://www.facebook.com/DMdirectory or email the picture to DMdirectory@comcast.net AFTER submitting this form Please be sure to include your name. Please ask if you need more assistance.
Your answer
email
(optional will NOT appear in the directory)
Your answer
Would you like to be included on the map?
If YES you must fill in the address information below (only the city,state will be on the map) if NO or already on then address information is optional
Street Address
(optional will NOT appear in the directory)
Your answer
City
(optional will NOT appear in the directory)
Your answer
State / Provence
(optional will NOT appear in the directory)
Your answer
Country
(optional will NOT appear in the directory)
Your answer
Zip Code
(optional will NOT appear in the directory)
Your answer
Please double check spelling / wording and names before submitting
Submit
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