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Membership Application - Paper / Check / US Mail |
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| ______ New Member | ______ Renewal | Date: ________________________ |
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Name: ______________________________________
Street: ______________________________________ ____________________________________________ Spouse's Name: ______________________________ Spouse's Employer: ___________________________ ____________________________________________ |
Employed By: _________________________________
Home Phone: _________________________________ Work Phone: __________________________________ Children Living At Home: (Names & Ages) _____________________________________________ _____________________________________________ |
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Please list any pets: ______________________________________________________________________________
Categories of Active Members |
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| _____ $ Special | _____ $75 Supporting | |
| _____ $1,000 Patron | _____ $50 Buddy | |
| _____ $500 Sponsor | _____ $35 Family | |
| _____ $250 Friend | _____ $20 Individual | |
| _____ $100 Benefactor | _____ $10 Junior (Age l6 & under) | |
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Please print the Membership Application form and mail the completed application, along with
your dues, to the Humane Society of Central Illinois, P.O. Box 401, Bloomington, IL 61702-0401. Contributions made to the Humane Society of Central Illinois are tax deductible to the full extent allowed by law. Thank you for joining the Humane Society of Central Illinois. We look forward to your participation. |
| The Humane Society of Central Illinois |
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Copyright © 2008 Humane Society of Central Illinois. All rights reserved.