Coalition for Pet Protection

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Membership Application Form

 
     
Name: ___________________________________ Address: ____________________________________
       
City: ______________________ State: _____ Zip: ___________ Home Phone: _________________
     
Work Phone: ___________________ Cell Phone: ___________________ E-Mail: ______________________
     
 

Please Check the Appropriate Membership Type

 
     
  o  $10.00 Student/Senior (60+) Member (1 vote) o  $30.00 Donor Member
  o  $15.00 Single Membership (1 vote) o  $50.00 Benefactor
  o  $25.00 Family Membership (2 votes) o  New Membership
    o  Renewal
   

Additional Contributions

Miscellaneous

   
$ _____ Homeless Pet Emergency Fund o  I am interested in receiving the "Paw Prints" newsletter via e-mail.
o  $15.00 Gift Membership o  I do not wish to be notified of CPP meetings.
o  I am interested in becoming a foster parent. o  I am interested in being a Paws Page sponsor.
   
     
 

Please mail this membership form and check to:
Coalition for Pet Protection
P.O. Box 23165
Lincoln, NE 68542

 
     
 

 

 
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