W.R.H.S Membership/Contribution Form

Please join us in our continuing efforts to promote and establish humane attitudes, and to prevent unnecessary suffering for animals in the Lawrence County area. Please join the Humane Society, or give a gift membership.

Membership Categories (Please mark proper category)

$2.50 Junior (under 18)
$10 Individual
$25 Family
$50 Organization (business or club)
$50 Supporting
$100 Benefactor
$400 Lifetime (one-time)

Please apply my membership donation to the following fund:

Shelter (operation and animal care)
Spay/Neuter Assistance Program
Building
General (Wherever needed)

This is a gift membership from:________________________________________________________

I would be interested in helping the shelter in the following manner:____________________________________

Please DO NOT publish my name as a donor. I would like to receive a shelter newsletter.

Name:_______________________________________________  EMAIL ___________________________
Address:_____________________________________________
City, State:___________________________________________
Zip:________________ Phone:__________________________

Please make checks payable to:         WHITE RIVER HUMANE SOCIETY
                                                    P.O. Box 792 • Bedford, Indiana 47421
Thank You For Your Support!