Memorial Coin Order Form

Please complete this form and send payment to via paypal to deweysgoldenjubilee@gmail.com
or if you need to pay by check, please make it payable to:
Dewey's Golden Jubilee
and mail to:
Karen Gerth
117 Maple Farms Road
Ephrata, PA 17522

All coins will be distributed during the Time of Remembrance at the Bonfire on Saturday evening, 10/7/2017. If you can not attend please specify in the message area below.

Please note: Payment must be received in advance to process your order.
All proceeds from this year's coins will be shared equally between three golden rescues and a pet therapy group founded by the DGJ instigator.

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Please provide the name you want to appear on the coin
So very sorry for your loss.