New Member Circle above if new member		.MEMBERSHIP APPLICATION To Help Those That Cannot Speak	Renewal Circle above if renewal
Junior Membership ( Non-voting, under 18 )	$5.00	Name __________________________________
Individual Membership	$10.50	Address ________________________________
Family Membership	$20.00	_____________________________________
Individual Lifetime Membership	$150.00	_____________________________________
Business Membership ( Non-voting )	$35.00	Phone No. ( ______ ) ______ - __________
$________ Contribution Contributions are ( tax-deductible )		Date ________ - ________ - ________
$_________ Monthly Pledge		I would like to volunteer, please contact me. Circle above to be contacted
Windows users, Please select File / Print & include with payment .Close window after printing Thank You		MAIL TO: Humane Society of Douglas County, Inc. P.O. Box 891 Superior, WI 54880-0891