The Humane Society of Granville County
P.O. Box 385, Butner, N.C. 27509
Pager # 919-691-0870

MEMBERSHIP APPLICATION

NAME_______________________________________________DATE______________

ADDRESS:
                 _______________________________________________________________
            Street or P.O. Box

                ________________________________________________________________
                City                                             State                           Zip Code
TELEPHONE NUMBERS:
                          Home___________________________________________________

                              Work___________________________________________________
EMPLOYER AND
    OCCUPATION________________________________________________________

NUMBER OF PETS:______________________________________________________

SPECIES OF PETS OWNED:_______________________________________________


Do you maintain a Kennel or Cattery or other animal related business?_________YES__________NO
      If  YES, name and type of business__________________________________________________

Primary interest: _____________Dogs  ____________Cats  _____________________Other

Do you receive any monies from any animal-related venture? __________YES    ___________NO
      If  YES, please explain:_____________________________________________________________

___________________________________________________________________________________

Other Humane and/or Animal-related memberships________________________________________

___________________________________________________________________________________

Have you ever been denied membership in a humane/animal-related club?________YES _______NO
           If YES, please explain:__________________________________________________________

___________________________________________________________________________________
Would you be interested in being a foster home?______________YES_______________NO
           If YES, what species_____________________________________________________________
Would you be interested in volunteering at the Granville County animal Shelter?
                                                ____________________YES_____________NO
In which of the following areas do you have an interest or have experience?
_____Advertising                        ______Fundraising                   _____Publicity
_____Social                                 ______Politics                           _____Animal Health
_____Volunteer                           ______Foster Home                 _____Other

How did you learn about the Society?
___________________________________________________________________________________

Do you agree to abide by the By-Laws and Code of Ethics of the Humane Society of Granville
         County upon acceptanace?____________YES_____________NO

__________________________________________     _______________________________________
Name ( Please Print)                                                     Signature

_____________________________________
Date
Levels of Membership:

Lifetime($300.00)_____________                         Sponsor($100.00)_______________
Patron($50.00)________________                        Regular($20.00) _______________
Youth(Under 15 yrs old)($5.00)_____________________


Please send application and membership fee to:

The Humane Society of Granville County
P.O. Box 572
Butner, N.C. 27509


Please indicate t-shirt size

____XX-Large          ____X-Large            _____Large          ______Medium
One per application, additional t-shirts are $10.00 each