VOLUNTEERS FOR ANIMALS

MEMBERSHIP FORM

 

NAME_____________________________________________________

 

ADDRESS__________________________________________________

 

CITY______________________________________________________

 

STATE______________ ZIP CODE_____________________________

 

TELEPHONE NUMBER________________________________________

 

E-MAIL ADDRESS__________________________________________

 

DATE________________ ACTIVE_______ CONTRIBUTING________

 

AMOUNT ENCLOSED$__________________

 

MAIL FORM TO:

VOLUNTEERS FOR ANIMALS
PO BOX 1621
BATAVIA, NY 14021