I want to start helping the animals today!

BECOME A SUPPORTING MEMBER!

Name:_____________________________________________________

Address:___________________________________________________

City:______________________________ Zip:_____________________

Phone:____________________________E-mail:___________________

Credit Card Number:____________________________ Exp: _________

q $75.00 Business

q 35.00 Family

q 25.00 Individual

q 10.00 Junior (under 18 years)

q 10.00 Senior (65 years and over)

q I am interested in a corporate membership

q I would like to volunteer my time to the shelter

Print form and send check or Mastercard/Visa information to:

Humane Society of Jefferson County

W6510 Kiesling Road

Jefferson, Wi. 53549