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