Animal Friends of North Central WV
Membership Form

Membership:

Choose One:   ___ New Member      ___ Renewal Membership

Choose One:   ___ Individual ($20 / year)      ___ Group/Family ($30 / year)

Contact Information

Name: ____________________________________________________________________

Home Address: ____________________________________________________________

City, State, Zip: ______________________________________________________________

Home Phone: ________________     Email Address: ________________________________________________

Family or group membership: (List Names and Relationships)

__________________________________________________________________________________________

__________________________________________________________________________________________

Interests

Please send me more information about:

___ Volunteering          ___ Working at the Thrift Shop         ___ Fund Raising

___ Fostering          ___ Shelter Work         ___ Transporting/Rescue          ___ Other

All members will receive the newsletters as well as notification of upcoming events.

Would you like to receive this information via (choose one)   __ Email      __ US Postal Mail

_____ Yes, you have my permission to publish my name as an Animal Friends' member.

_____ No, please don't publish my name.