Membership Application
P.O. Box 37, Goshen, NY  10924
Ph. 845-294-3984

Please provide the following contact information:

First Name _________________________________________________
Last Name _________________________________________________
Organization _________________________________________________
Street Address _________________________________________________
City ____________________________ State:____ Zip:_________
Home Phone _________________________________________________
E-mail _________________________________________________
  Choose one of the following options:
________ Individual Membership: $25.00
________ Family: $50.00
________ Corporate: $1000.00

Please print, fill out your membership application and mail your check to the address shown above.  Thank you for your support!
Your membership donation amount is tax deductilble!

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Copyright 2007 Goshen Humane Society, Inc. All rights reserved.