H.E.A.D.S. Membership Form

     Name:____________________________________________

     Address:___________________________________________

     City:_____________________________ Zip Code:_________

     Home Phone:_______________________________________

     E-mail Address:_____________________________________

          Membership Type (please check one)

          ____Student   $6.00          ____Family   $30.00

          ____Senior   $10.00          ____Company   $50.00 

           ____Single     $25.00        ____Contributor    $_______          

I / We are interested in Helping HEADS:

_____     CONTRIBUTOR - (Food, Blankets, Bleach, Etc.)

_____     VOLUNTEERING - (at Shelter when established)

_____     FUNDRAISING -(Serve on Committee)             

_____     EDUCATION - (Serve on Committee)                

_____     DONATION - (Monetary)                                 

_____     FOSTERING A HOMELESS PET- (in your home)

                         

MAKE YOUR CHECK PAYABLE TO:  H.E.A.D.S.            

PRINT THIS FORM, COMPLETE AND MAIL WITH CHECK TO:

H.E.A.D.S. - P.O. Box 312 - Trenton, MI  48183               

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