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Coalition for Pet Protection |
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Membership Form |
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| Name: ___________________________________ | Address: ____________________________________ |
| City: ______________________ | State: _____ | Zip: ___________ | Home Phone: _________________ |
| Work Phone: _________________ | Cell Phone: ___________________ | E-Mail: ______________________ |
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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 |
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Additional Contributions |
Miscellaneous |
| $ _____ Homeless Pet Emergency Fund | o I am interested in volunteering. | |
| o $15.00 Gift Membership | o I am interested in becoming a foster parent. | |
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Please mail this membership form and
check to: |
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