NAME(S):________________________________ DATE:__________
ADDRESS:_______________________________ HOME PHONE:_______________
CITY/STATE/ZIP:__________________________ WORK PHONE:_______________
[ ] Check here if you would like us to call you to volunteer at fund raising activities
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TYPE MEMBERSHIP
[ ] Junior (Student) $5.00 [ ] Senior $5.00 [ ] Single $10.00 [ ] Family $15.00
[ ] Classroom $25.00 [ ] Business $100.00 [ ] Corporate $500.00 [ ] Other _______
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Along with my membership fee, I would like to donate additional funds to help the St. Bernard Parish Animal Shelter and Friends of the Animal Shelter in their vital work for all the abused, homeless, and unwanted pets in St. Bernard Parish by my extra contribution of
$___________. I understand that if I want my this additional donation to specifically benefit one or more of the programs listed below, I will check it off; if none are chosen, my donation will be added to others and used where most needed by Friends of the Animal Shelter to exclusively benefit our shelter:
[ ] Animals for Retirees Fund (ARF) [ ] Shelter Needs & Projects
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