DONATION FORM

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q Keeper Sponsorship $25-49	q The Canine Club $250-499
q Defender Sponsorship $50-99	q The Feline Club $250-499
q Rescuer Sponsorship $100-249	q The Guardian Club $500-999
	q The Humanitarian Club $1000 & up

Enclosed is $_____________________ Balance Due $______________________

Payable as follows:    q monthly q quarterly q semi-annually

Name________________________________________________________________

Address______________________________________________________________

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Phone__________________________________

q Please check this box if your donation is specifically for the Friends for Life for Ferals TNR Program

Otherwise, please use my donation specifically for: _____________________________________________________________________
(If not specified, donations will be used wherever the need is greatest.)

Please make checks payable to:
   Humane Society of Morgan County, P.O. Box 705, Berkeley Springs, WV, 25411.

The HSMC is a 501(C)3 not-for profit organization. All contributions are fully tax deductible.