PARKLAND HUMANE SOCIETY INC.

MEMBERSHIP FORM

To become a member of the Parkland Humane Society, please complete this form and forward it with your membership fee or donation to:

Parkland Humane Society

Box 805

Dauphin, MB   R7N 3B3

Name:_____________________________________

Address:___________________________________

City/Town:_________________________________        Province:________________

Postal Code:________________________________        Phone:__________________

E-mail:____________________________________

Please indicate choice:

Individual   $10.00        °                                              Supporter     $50.00     °

Family     $20.00          °                                              Patron        $100.00     °

Pet      $5.00                °                                              Corporate   $100.00   °

Pet’s Name:______________________                     Other   $__________  °

Please make cheques payable to: Parkland Humane Society Inc.

Tax receipts will be given for memberships and donations $10.00 and over.

Memberships are yearly and expire in December of each year.

Membership cards and regular newsletters are issued by mail.

 
Thank-you for your support!

 
Interest in volunteering?    Yes___________            No__________