For Pets Sake Humane Society
Membership

Name and Mailing Address:

Name:_______________________________________________

Address:   ____________________________________________

____________________________________________________

Home Phone:________________________________

Work Phone:_________________________________

E-mail Address:______________________________

Date:____________________

Volunteer Interest:: Select Volunteer Activity Fundraising Grant Writing Foster Care Animals Transportation of Animals Newsletter Publicity Web Site Development Membership on Board of Directors

Membership is for the year beginning July 1st.

Select membership category Good Friend, $10 Supporterl, $25 Contributor, $50 Animal Advocate, $100 Guardian Angel, $250 Pack Leader;$500

Donation to the Endowment Fund:_____________

Total enclosed:_________________

Please send me information about Business Membership:______

Please print this form and mail your tax-deductible membership and/or contribution to: For Pets' Sake Humane Society, PO Box 1705, Cortez, CO 81321

Our email address: For Pets Sake Humane Society