Membership Application - Paperless / Credit Card HSCI relies solely on donations, fundraising, and memberships to fulfill our mission. We receive no federal, state, or local government funding. Thank you for your support! We use the convenience of PayPal for online contributions. Making your donation using PayPal is fast, free, and secure!  PayPal accepts Visa, MasterCard, American Express, and Discover. If you would prefer not to use PayPal, please call our office at (309)451-1000 and pay with your credit card over the phone.

	Click the link for the Membership level you would like to contribute. The PayPal webpage will display.
	Review all payment details carefully.
	Click the Pay button when finished and wait to receive a confirmation message.
	Select the option to return to the HSCI website.
	Complete the Membership Information form below. (Step Two - Information)

Step One  -  Payment

$1,000 Patron $500 Sponsor $250 Friend

$100 Benefactor $75 Supporter $40 Family

$25 Individual $      Other

Step Two  -  Information

New Member

- or -   Renewal - Required

Name:	- Required
Street:	- Required
City:	- Required
State:	Illinois Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming - Req.    Zip Code:  - Required
Phone:
Email Address:	- Required

Please list any pets:

Would you like to be added to our email list and receive occasional emails regarding HSCI news and events?  Email addresses are used only for our internal use and not shared outside of HSCI.

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After completing payment and filling in the form, click the 'Submit Membership Form' button.

Your membership donation, tax deductible to the extent allowed by law, can help the Humane Society of Central Illinois in its efforts to prevent animal abuse and neglect through the programs we offer.  Thank you for becoming a member!

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