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!

When you are finished printing please Click here to go back

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