AS A MEMBER; A DONOR; A VOLUNTEER
MEMBERSHIP FORM
NAME: _____________________________________________
ADDRESS: __________________________________________
CITY: ______________________________________________
STATE/ZIP: _________________________________________
PHONE: _______________ EMAIL: ______________________
Please add me to your Mailing List
MEMBERSHIP CATEGORIES
Individual . . . . . . . . . . . . $25.00 per year
Family . . . . . . . . . . . . . . . $35.00 per year
Senior . . . . . . . . . . . . . . . $10.00 per year
Business Sponsor . . . . . $100.00 per year
Other Donation. . . . . . . $____________
Memberships can be purchased at the shelter or
mailed in with your check to the address below.
I’LL VOLUNTEER MY TIME. PLEASE CONTACT ME
I prefer to be contacted:
By Phone
By e-mail
PLEASE SEND COMPLETED FORM TO:
Columbia Humane Society
2084 Oregon St.
St Helens OR 97051
OUR HOURS ARE:
Tuesday–Saturday: 11:00am to 5:00pm
Phone: 503–397–4353 E-mail: