dogshome.com · web viewapplication for membership to: the company secretary, the lost dogs’...
TRANSCRIPT
APPLICATION FOR MEMBERSHIP
To: The Company Secretary, The Lost Dogs’ Home, 2 Gracie Street, North Melbourne I hereby apply to be a member of The Lost Dogs' Home. In the event that this application is accepted, I confirm that I agree to be bound by the Company’s Constitution. The Subscription Fee of $10 accompanied this Application and my credit card details have since been removed for the purposes of providing this application with the Board of The Lost Dogs’ Home.
Applicant (print name):
Residential address:
Email address:
Contact phone number:
Name of pet/s:(please indicate if dog or cat)
Why are you interested in becoming a member of the Home?
Please detail any previous involvement with the Home?
Which other interest groups or organisations are you associated with?
Do you support any other charities or not-for-profit organisations? [ ] Yes [ ] NoIf so please specify which charities?
What is most important to you as a supporter of the Home?
What services are most important to you?[ ] Shelter services for lost, stray and surrendered dogs and cats[ ] Reuniting lost pets with their owners[ ] Adoption services for unwanted dogs and cats[ ] Veterinary care for stray, injured, sick, elderly and neglected animals[ ] Behaviour rehabilitation for unwanted dogs who need extra training and
socialising before adoption[ ] Foster care program for underage, injured, ill and rehabilitating animals
needing extra support and care before adoption[ ] National awareness campaigns for responsible pet ownership[ ] MADI – mobile low-cost, desexing service[ ] Pet Licence online test that teaches prospective adopters about
responsible pet ownership
Applicant’s signature Date
To be completed by the CEO and Board of Directors: I confirm that the applicant has paid the subscription fee of $10
Andrew Israel (CEO) Date
Proposer (print name)
Proposer’s signature Date
Seconder (print name)
Seconder’s signature Date
SUBSCRIPTION FEE(to accompany a Member Application Form)
Individual Membership $ 10.00
I would like to include a donation of
$
Total amount enclosed $
[ ]
Please find enclosed a cheque or money order (made payable to The Lost Dogs’ Home)
[ ]
Please find credit card details below
Credit card type
[ ] Visa [ ] Mastercard
[ ] American Express
Name on card
Credit card number / / /
Credit card expiry date
/20
Signature
Thank you for your support.Donations of $2.00 or more are tax deductible.