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HUMANE SOCIETY OF BURNETT COUNTY, INC.
P.O. BOX 35
DANBURY, WI 54830

ANNUAL MEMBERSHIP FEES


__________$10.00 Junior between ages 15 and 17 inclusive, non-voting
__________$20.00 Individual
__________$30.00 Family, two partners & children under 15
__________$50.00 Sponsor
_________$100.00 Patron
_________$500.00 Benefactor
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DONATION

I would like to pledge $_____________a month for a total of $_________per year.
or

Special Needs giving: I would like my donation to be applied to the following:
$________for the Spay and Neuter Fund
$________for medical care
$________for food for the pets of the elderly
$________for the building fund for the shelter
$________to be used as needed

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____I would be interested in becoming a foster parent for a dog or cat
____I would like to volunteer to help in any way I can

Name:__________________________________________________________

Summer Mailing Address:___________________________________________

Winter Mailing Address:____________________________________________

Local Telephone:________________

e-mail Address:________________________________________________

Please mail completed form and your check to HSBC at the above address.