| and mail to the address below or Register On-Line |
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| MEMBERSHIP |
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| YES, I'd like to help the Frederick County Humane Society help the animals. Enclosed is my membership donation of: |
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| — $25 | Individual member | — $10 | Senior member | ||
| — $35 | Family member | — $20 | Senior Family | ||
| — $50 | Patron member | — $10 | Junior Member | ||
| — $100 | Benefactor | Age of junior member — | |||
| — $500 | Sustaining | — $250 | Corporate (annual renewal) | ||
| — $1,000 | Lifetime member | ||||
| Name |
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| Address | |||||
| Telephone number | |||||
| Email Address | |||||
| I'm already a member, but wish to make an additional donation of | |||||
| $ — | |||||
| This gift is: | |||||
| In honor of : | |||||
| In memory of: | |||||
| Please notify: | Name: | ||||
| Address: | |||||
| Payment Method: | |
Credit Card __ | |||
| __MC __VISA __DISCOVER __AMEX | |||||
| Expiration_____________________ | Credit Card # ______________________________ | ||||
| Signature |
____________________________________ | ||||
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| Mail your tax-deductible contribution to: | Frederick
County Humane Society 5712-D Industry Lane Frederick, MD 21704 |
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