HSCC Online Membership Application
Only provide your Credit Card Information if you plan on copying this application mailing it in. If mailing, send it to Humane Society of Cowlitz County, P. O. Box 172, Longview, Washington 98632.
Name:
Address:
City:
State and Zipcode:
Telephone Number:
Email Address:
Please check type of Membership you are requesting:
Kennel Sponsor - $1000/year
Life Member - $600/year
Circle of Friends - $300/year
Business - $100/year
Family - $35/year
Individual - $25/year
Senior/Junior - $15/year
Other - ________
Charge my Gift to:
Visa
Master Card
Discover
Credit Card Number:
Expiration Date:
Yes - I want to help remodel the Shelter. Sign Me Up To Donate Every Month:
Amount: __________
Donations are tax deductible under Section 501 C3 of the US IRS Tax Code
Make your payment using our convenient PayPal link:
Click here:
