Application for Membership
Name _____________________________________________
Date _____________________
Address ________________________________________________________________________
City __________________________
State ______ ZIP _______ Phone ________________
Email _______________________________________________________________________
Membership/donation enclosed: $________
Any amount you can afford to give
at this time is appreciated. We have designated categories of:
$100/year - Gold membership
$40/year - Family membership
$25/year - Single membership
$15/year - Friend of animals(youth 12-18, seniors
65 and older)
Please make checks payable to Petersburg Humane Association
and send to PO Box 1417, Petersburg, AK 99833.
Thank you for your support!
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