Name:

Address:

City,State,ZipCode:

_________________________________________

_________________________________________

_________________________________________

Eau Claire County
Humane Association

Membership/Donation Form
Regular Memberships: ___ $5 Pet (non-voting)
___ $5 Youth (under 18, non-voting)
___ $15 Senior Individual (over 61)
___ $25 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:
(non-voting)

 ___ $75 Annual Dog Cage Sponsorship
___ $75 Annual Cat Cage Sponsorship
___ $_____ General Operating Fund
___ $_____ Spay/Neuter Fund
___ $_____ Animal Medical Fund
___ $_____ Other _____________

General Acknowledgment Policy:
Acknowledgments are usually sent to all memberships and donations over $99; however, if you prefer that we save the postage to help the animals, please know that we are thankful for your support. If you would like an acknowledgment sent to the above address,
please check here. ____

Honorarium/Memorial Donation Acknowledgment
Membership/Donation is:

___in honor of
___in memory of

____ person
____ pet

 Name __________________________________
Name___________________________________

Send acknowledgment to:
(amount will not be disclosed)

Name: _____________________________________________________
Address:___________________________________________________
City, State, Zip Code___________________________________________

Total amount enclosed: $ ___________
Make check payable to: ECCHA

Mail to:
Eau Claire County Humane Association
3900 Old Town Hall Road
Eau Claire, WI 54701

We are a 501(c)3 non-profit organization. All memberships and donations are tax deductible.