| Please Inidicate All That Apply |
| Membership |
| Individual |
 |
$20 |
|
____ |
|
Family |
|
$35 |
|
____ |
| Jr. (under 18) |
|
$5 |
|
____ |
|
Pet |
|
$2 |
|
____ |
| Dog Lover |
|
$50 |
|
____ |
|
Cat Lover |
|
$50 |
|
____ |
| Business |
|
$100 |
|
____ |
|
Pet Fanatic |
|
$150 |
|
____ |
| MDHS Builder |
|
$500 |
|
____ |
|
Lifetime Member |
|
$1,000 - $1,999 |
|
____ |
| Lifetime Benefactor |
|
$2,000 - $4,999 |
|
____ |
|
Lifetime Leader of the Patk |
|
$5,000 or more |
|
____ |
|
| Donations |
| Donation only |
|
$____________ |
|
Memorial |
|
$____________ |
|
| ____ Check here if you wish to be a Hush Puppy (Anonymous) |
|
| Volunteer |
| I am interested in helping in the following areas: |
| ____Membership |
|
____Administration |
|
____Education |
|
____Fund Raising |
| ____Public Relations |
|
____Foster Home Program |
|
____Animal Shelter |
|
|
|
|
| Contact Information |
| Name |
|
__________________________________________ |
| Address |
|
__________________________________________ |
| Phone |
|
(H)_________________
(W)_________________ |
|
|
Please send this form with your tax deductible donation to:
MonDak Humane Society, PO Box 1572, Williston, ND 58802
|
