HOPE Membership Form

     Please print, complete, and send with appropriate yearly payment to HOPE for Animals, P.O. Box 1341, Thibodaux, Louisiana 70302.  Thank you.

Date:  _______________________________________________

Full Name:    __________________________________________

Phone No.:    (        ) ____________________________________                    

Home Address:    ______________________________________

                              ______________________________________

Email Address:    _______________________________________

___ I am a new member

___ I am a renewing member

Membership Fees:

(Please circle one)

Student:  $3.00

Individual:  $5.00

Family:  $10.00

Business:  $25.00

Big Dog:  $100

Top Cat:  $100