LET ME HELP THE SOURIS VALLEY HUMANE SOCIETY ACCOMPLISH ITS MISSION!!
Name_______________________________________________________Phone___________________________________________
Address_________________________________________________City____________________________State_____Zip_________
E-mail Address________________________________________________________________________________________________
q Check here if you do not want your name in the SVHS Newsletter. DATE____/_____/______
A. Yearly Membership: CIRCLE CHOICE
Jr. (Non-voting)-$10 Individual-$25 Family (2 votes)-$50
Pet Membership-$5 Pets Name___________________ Sustaining Legacy-$100-$499
Silver Paw-$200 Gold Paw-$201-$500 Platinum Paw-$501-$1000
Lifetime Membership-$1000-$5000 Legacy-$5001 and up
B. $_____________ in memory-past person(s) or pet(s) C. $_____________ in honor-living person(s) or pet(s)
Name(s)____________________________________ Name(s)__________________________________________
Send acknowledgement to: Send acknowledgement to:
Name__________________________________________ Name__________________________________________
Address________________________________________ Address________________________________________
City ________________________ State_____Zip_______ City_________________________State_____Zip_______
D. Cage Sponsorship-$20 each CIRCLE CHOICE: DOG CAT NO PREFERENCE
Number of cages_________________________________
Specify wording you wish to appear on your sponsorship sign
__________________________________________________________________________________________________
__________________________________________________________________________________________________
E. Additional donation for: $_______animal care $___ ____ shipping/handling of pet food
$_______other (specify) _____________________________________________
Please add sections A, B, C, D and E.
Enclosed is my total tax-deductible contribution in the amount of $______________.
Mail to:
SVHS
1935 - 20th Ave SE
Minot, ND 58701