Membership Application Form

MISSISSAUGA HUMANE SOCIETY

Membership Application Form
The Mississauga Humane Society's mission is to promote animal welfare through education and to find each of our rescue dogs and cats a forever home!
Name

First Name Last Name
Social Media Alias/Handle
Address

Street Address

Unit

City Province

Postal Code
Phone Number

Area Code Phone Number
Email
example@example.com
Would you like to be added to our mailing list?

Yes No
How Did You Hear about membership?

Website Instagram Facebook Friend/Family
By signing below, I confirm that I agree with the following statements:
- I support the Mississauga Humane Society's (MHS) mission statement, as written above.
- I attest that I have not been convicted of any offence under the laws of any Canadian Jurisdiction, respecting the care, custody, or treatement of an animal
- I agree to follow and respect the Membership Requirements and certify that the information provided on this application is true.
- I have read and understood the Membership Requirements and the Ontario Human Rights Code, and if at any time, should I violate them, the MHS board has the authority to terminate my membership without refund.
Date

Month Day Year
Date
Signature

Clear
Membership Type

Please indicate which type of membership, and your preferred payment method
PLEASE INDICATE WHICH MEMBERSHIP YOU ARE APPLYING FOR:

ANNUAL MEMBERSHIP - $45 SENIOR ANNUAL MEMBERSHIP - $35
PLEASE INDICATE YOUR PREFERRED PAYMENT OPTION
When approved, you will receive an email indicating acceptance and payment method
MEMBERSHIP IS VALID FOR 12 MONTHS FROM DATE OF PURCHASE

* Membership fees must be paid by the applicant upon approval of the application

* Tax receipts will be sent to the applicant via email

* In accordance with the law, MHS will not trade, sell, or rent members' name or private information
I'm interested in learning more about volunteer opportunities with MHS.
Please add your preferred method of contact here; and any initial questions you may have
Should be Empty:

MISSISSAUGA HUMANE SOCIETY

Membership Type