Animal Friends of North Central WV
Support / Interest Form

Date  __________________________________

Contact Information:

Name: ____________________________________________________________________

Home Address: ____________________________________________________________

City, State, Zip: ______________________________________________________________

Home Phone: ________________     Email Address: ____________________________________________________________

Family or group: (Please list names)__________________________________________________________________________

_____________________________________________________________________________________________________

Financial Support:

Choose One:   ______ New      ______ Renewal

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

To make an additional contribution, fill in amount here: $ _______________

(Make checks payable to Animal Friends of NCWV. Contributions are tax-deductible.)

Volunteer Support:

Please contact me with more information about:

___ Volunteering          ___ Working at the Thrift Shop         ___ Fund Raising        ___ Fostering

___ Shelter Work         ___ Transporting/Rescue          ___ Other - Please describe:

________________________________________________________________________________________________

Would you prefer newsletters and information via (choose one)   __ Email or       __ US Postal Mail?

(Please note that choosing "Email" helps keep postage costs down.)

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

_____ No, please don't publish my name.

Send form and contribution to:
Animal Friends of NCWV
252 Brewer Road
Morgantown, WV 26508

Thank You!