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Coalition for Pet Protection


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


  $ _____ 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