Alliston & District Humane Society

P.O. Box 378, Beeton, Ontario L0G 1A0 Telephone: (705) 458-9038
Fax: (705) 435-2851 Registered Charity # BN 13529 8081 RR0001

MEMBERSHIP/DONATION FORM

NAME (please print)_____________________________________________

ADDRESS _____________________________________________

PHONE ______________________________________________

Membership Renewal ___ New Member ____    Post-Dated Cheques ________

Additional Donation ____    Donation Only ____

Total Amount Enclosed______    Method of Payment: Cash __ Cheque __

I hereby apply for membership in The Alliston & District Humane Society and agree to
support the aims and objectives of the Society.

SIGNATURE: ________________________________ Date:____________________

TYPE OF MEMBERSHIP AND ANNUAL DUES

Family $25 __ Voting members: Adults (over 18)_____ Non-voting members: Teens (13 - 18)_____
Juniors (under 13) _____
 
Individual $15 __ Senior $ 5 __ Junior $ 5 (13 and under) __

Receipt required (amounts over $10 only) ___

RECEIVED BY _______________________ DATE_______________________ RECEIPT NUMBER __________