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Coalition for Pet Protection

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Membership 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 volunteering.
  o  $15.00 Gift Membership o  I am interested in becoming a foster parent.
     
     
 

Please mail this membership form and check to:

Coalition for Pet Protection
P.O. Box 23165
Lincoln, NE 68542