___ $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:

Date: _______________________________

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?_______________________________