GIFT - MEMBERSHIP Circle if new member MEMBERSHIP APPLICATION To Help Those That Cannot Speak Circle if renewal Jr Mbr Non-voting, under 18 $5.00 Name ___________________________     Adult Mbr $10.50 Address _________________________     Family Mbr $20.00 ________________________________     Lifetime Mbr $150.00 ________________________________     Business Mbr, Non-voting $35.00 Phone No. ( ____ ) _____ - _________         $________ Contributions are tax-deductible Date _______ - _______ - _______     $_________ Monthly Pledge I would like to volunteer, please contact me. Circle to be contacted       Windows users, select File/Print & include with payment Thank-You MAIL TO: Humane Society of Douglas County, Inc. P.O. Box 891 Superior, WI 54880-0891   INSTRUCTIONS: Complete this form and return it with payment or donation to the above address THANK-YOU. CLICK HERE for a larger version of this form