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Mid-Atlantic Chinese Shar-Pei Rescue Operation, Inc.
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Application for Membership |
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Non-Profit, Tax Deductible
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Name: ___________________________________________
Age (optional): _______________
Address: ______________________________________________________________________
City: ____________________________
State: _____________ Zip: _______________
Home Phone: ________________________ Work
Phone: ____________________________
Please tell us about your Shar-Pei members of your household:
Pet Name: _____________________________ Age: _____
Sex: _____ Birthday: __________
Pet Name: _____________________________ Age: _____
Sex: _____ Birthday: __________
Pet Name: _____________________________ Age: _____
Sex: _____ Birthday: __________
Pet Name: _____________________________ Age: _____
Sex: _____ Birthday: __________
Are you interested in helping with the rescue operation? Yes _____ No _____
___ Fostering ____ Surrogate
Parent ____ Phone Calls/Clerical ___ Transporation
___ Funds Collections ___ Events Coordinator
____ Newsletter ___ Other
The following is the suggested membership contribution:
Individual $15.00 per year Couple
$25.00 per year Junior (12 - 18 years old)
$15.00 per year
Contribution enclosed:
$____________
Additional donations to the rescue operation:
$____________
Thank you for your support.
Signature: _______________________________________
Date: ______________________
Signature: _______________________________________
Date: ______________________
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Make checks payable to: |
MACSPRO
P.O. Box 34034
Bethesda, MD 20827 |
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