EmailMe Form - MEMBERSHIP APPLICATION - TRI-COUNTY COLLIE RESCUE

Email

(Renewing members, please indicate if this is a new email address for you)

Name

First Last

Other Family Members (if family membership):

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone

### - ### - ####

Volunteer Opportunities

Please indicate if you can help with any of the following activities:

Foster a collie

Yes!

No.

Maybe

Other ongoing activities we need help with:

Check nearby animal shelters when called?

Do local home/yard checks for prospective adopters?

Transport a dog?

Miles you are willing to travel

Can you help us with any of the the Club's other activies? (Please check the items you may be willing to assist with):

Is there any service, talent or business affiliation that you have that you feel could help TCCR? If so, please explain:

We welcome your suggestions and comments:

Membership Dues:

$15.00 per year - Individual

$20.00 per year - family

Donation

Amount:

Total amount:

PAYMENT INSTRUCTIONS:

You may send your membership fees and donations via check payable to "TCCR" addressed to: c/o B. Nemoff, 24220 Coolidge, Oak Park, MI 48237

You may pay via charge card or Paypal at our Paypal address by clicking on the "Paypal" button on our website.

Thank you and Welcome!!!