Eau Claire County Humane Association 
Online Membership/Donation Form

We are a 501(c)3 non-profit organization
All memberships and donations are tax-deductible.
Name:
 *
Street Address:
 *
City:
 *
State:
 *
Zip Code:
 *
E-mail address:
 *
  ( * = required field )
Regular Memberships: $5 Pet (non-voting)
  $5 Youth (under 18, non-voting)
  $15 Senior Individual (over 61)
  $30 Senior Couple (over 61)
  $30 Adult Individual
  $50 Adult Couple
Humanitarian Memberships: $100  Individual
  $100 Corporate (non-voting)
  $200 Couple
  $201-500 "Supporter"
  $501-1000 "Sustainer"
  $1000+ "Advocate"
Miscellaneous Donations: $75 Annual Dog Cage Sponsorship 
  $75 Annual Cat Cage Sponsorship
  Other: $
  Special purpose $
  (Please fill in special designation for your donation in the above larger box)

General Acknowledgement Policy:

Acknowledgements are sent to everyone who becomes a member or donates, regardless of the amount of the donation. However, if you prefer that we save the postage to help the animals, please know that we are thankful for your support. If you do NOT wish to receive an acknowledgement, please check the box below.

"No, I do not wish to receive an acknowledgement"

Honorarium/Memorial Donation Acknowledgement
Donation is: a

Name:

 

For what amount? $

Send Acknowledgement to:

don't send

Name

Address

City, State, Zip code

Please disclose the amount
when you send the acknowledgement

Total amount donated: $

 

Thank You for Your Support.

To continue with online donation/dues, please
Please be patient waiting on the "submit" button - It sometimes takes up to 25 seconds (usually less).

Please notify the webmaster if the form doesn't work!
click HERE to download an interactive adoption form in .pdf format
THEN:
Download the form, type in the data, save the form, and send as an attachment
Fax it to us at (715) 839-1664,
-OR-
Snail Mail it to us at: ECCHA
3900 Old Town Hall Rd,
Eau Claire WI 54701