MEDINA COUNTY
                  SOCIETY FOR THE PREVENTION OF CRUELTY TO ANIMALS
                                               MEMBERSHIP FORM

                                        Welcome, New Member!!

____ Single        $25.00                    ____ Senior           $10.00 per person
____ Family       $40.00                     ____ Lifetime         $275.00 per person
____ Student     $10.00                     ____ Corporate     $200.00
         
(18 years or younger)                              (Includes 4 ads in Newsletter + link on web)

Join on line at the bottom of this page.

                         
Members are mailed a copy of our Quarterly Newsletter

In addition to my membership I would like to make a:                 
_____ Donation $_______                         
_____ Memorial $_______                          

In Memory of:__________________________________________ 
 
Please make all checks payable                            Date Paid:____________ 
to the Medina County S.P.C.A.                                 Check #: _____________
PO Box 135                                                                  Amt. Paid: ____________
Medina OH 44258-0135                                       
                                                                                   
Mr.                                                                               
Mrs.                                                                             
Mr. & Mrs. 
Ms. _______________________________________________________
 
Address: ___________________________________________________
 
City: _______________________ State: ______ Zip: ________________ 

Phone: _____________________ E-Mail: _________________________ 

I am interested in finding out more about the following: 
____ Adoption Committee              ____ Being a Cat Foster Home 
____ Fundraising Committee         ____ Being a Dog Foster Home 
____ Newsletter Committee           ____ Membership Committee 
____ Humane Education                 ____ Grant Writing Committee

Join on line...