HAS Membership Form

Membership/Donation Form
Name *

First Name Last Name
Mailing Address *

Street Address

Street Address Line 2

City State

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 Type Membership Level

I also wish to make a Donation Free

My Donation

Total $ 0.00

Membership/Donation Form