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Membership/Donation Form
Name:
Address:
City:
State:
Zip:
Phone:
E-mail Address:
Regular Membership
Humanitarian Club
$30
Adult Individual
$
Supporter ($201-$500)
$50
Adult Couple
$
Sustainer ($501-$1,000)
$15
Senior Individual (over 61)
$
Advocate ($1,000+)
$25
Senior Couple (over 61)
$200
Couple
$5
Pet (requires other membership)
[no voting privileges]
$100
Individual
$5
Youth (under 18)
[no voting privileges]
$100
Business
[no voting privileges]
$75 Annual Cat Cage Sponsor
$75 Annual Dog Cage Sponsor
$
General Operating Fund
$
Spay/Neuter Fund
$
Mettler Emergency Medical Fund
$
Other
Please Specify
Membership/Donation is:
in honor of
in memory of
person
pet
Send acknowledgement to:
Name:
Address:
If you do not want an acknowledgement sent, please check here
we are grateful for your support.
Yes, I want to remember the ECCHA. Please send me information on planned giving.
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NOT
required for payment.