HAS Membership Form

Membership/Donation Form
Name*

First NameLast Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
A tax receipt will be sent via email. Watch for a message from Treasurer@HeadwatersAnimalShelter.org

Membership Fees are as follows:

Individual - $25.00	Family - $35.00
Corporate - $250.00	Lifetime - $500.00

Membership fees are due the beginning of October of each year.

Membership/Donation *

Membership Type $ Free

Membership TypeMembership Level
Item subtotal:$0.00

I also wish to make a Donation$0.00

My Donation
Item subtotal:$0.00

Total $0.00

Membership/Donation Form