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Shelter Central
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It’s easy! Print this form and send it to us with your payment. When paying by MasterCard/Visa or P.O.#, feel free to fax this form to us at 303-792-5333. If mailing, send to: American Humane Association, Dept 0827, Denver, CO  80263-0827.

Yes, our agency wishes to enroll/renew as a member of AHA. Enclosed is our annual fee.

Select one:
$25 Affiliate Member
$50 Supporting Member
$100 Network Member

Date

Contact Information:

Agency name

Director/dept. head name

Title

Mailing address

City

State/province   Zip

Country

Agency phone ()Ext

Director’s phone ()Ext

Fax ()

Email

Website

Payment information:

Check or money order made payable to American Humane Association
Purchase order #
VISA Mastercard

Expiration date (required)
Card #

Print name as it appears on the card

Signature________________________________________________________________

Agency Information:

Agency type (check only one):
local (city, county, etc.)
state
foreign
national
international

We are a (check only one):
shelter
non-shelter

If you are a sheltered organization, check all that apply:
animal control facility
private non-profit
private non-profit with animal control contract
breed rescue
no-kill
other_____________________

If you are a non-sheltered organization, check all that apply:
animal control officer
rescue group
foster home network
state federation
no-kill
other___________________________

We have a (check all that apply):
spay/neuter clinic
full-service charitable veterinary clinic
mobile adoption vehicle
mobile spay/neuter vehicle
wildlife center
thrift store
on-site retail store
off-site retail store
off-site adoption center with retail store
full-service veterinary clinic
boarding/day care facilities
grooming facility (open to the public)
other______________________________

We employ _______ permanent full- and part-time people.

Last year, we handled __________ animals, including animals that we fostered, adopted, neutered, etc. through other types of agencies.

Our budget for the most recent fiscal year was $___________.

Humane education director
Name
Phone()Ext

Cruelty investigation director
Name
Phone()Ext

Staff veterinarian
Name
Phone()Ext

 

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