Virginians for Animal
Welfare
Membership Form
I want to become a member of Virginians for Animal Welfare, a charitable foundation organized under 501(c)(3). All contributions are tax deductible. Membership in VAW automatically confers membership in Virginia Voters for Animal Welfare. Annual membership in VAW is due every January 1.
Select a membership
category:
___ $25/year – Associate Member
___
$100/year – Full Member
Full membership confers voting rights on Board membership.
This membership can be paid
for on a monthly basis at $10/month.
___ $250/year – Sustaining Member
Sustaining membership confers voting rights on Board
membership and an invitation to a special event.
___ additional
contribution of $__________
Member
information:
First Name:
___________________ MI: ____ Last
Name:____________________________
Physical
Address:
____________________________________________________________
City:
____________________________________ State: ________ ZIP:
________________
Mailing
Address:
____________________________________________________________
City:
____________________________________ State: ________
ZIP:_________________
Email:______________________________________________________________________
Home Phone:
_________________________Work Phone: ____________________________
Cell Phone:
_______________________________
To what other animal groups do you
belong?_________________________________________
___________________________________________________________________________
Signature
Date
Please
make checks payable to Virginians For Animal Welfare and mail to:
Virginians for Animal Welfare
3318 Bust Head Road
The Plains, VA 20198