Yearly Membership/Sponser Applicaion

I would like to join with the Animal Shelter Inc. and help care for homeless animals as:

_____ A Senior Member
 
 $10 
_____ Junior Member
 
 $5 
_____ A Family Membership
( 2 Adults + All Dependants 18 and Under )
 $15 

 

_____ I would like to sponsor a specific animal:

      _____ Cat $10 / Month
      _____ Dog $15 / Month
      _____ Horse $60 / Month
      _____ Please send me a list to choose my own animal.
      _____ Please assign me a needy animal and send me information about it.

 

Name: _______________________________________
Address: _______________________________________
E-Mail Address: _______________________________________
Phone: _______________________________________
Additional Family Members: _______________________________________
_______________________________________
_______________________________________

Mail to:
    Animal Shelter Inc.
    HC 65, Box 390
    Rome, IN 47574


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