Membership Form
Application For Membership

(After completeing this form please print it out and mail it to us. Thank you)

 Whangarei SPCA
P O Box 564
Whangarei
New Zealand
Phone (09) 438 9161

Name

Address1

Address2

Address3

Phone No.
 E-mail Address


Can You Help?
Emergency Field Worker
Caring For Animals AtThe Center
Help With Fundraising Efforts
Help At Our Housie (supper,calling)
 Foster Sick or Young Animals
Donation
Other (please list below)
Membership Type
Juniors
 $ 5.00
Annual Members
 $ 10.00
Family Members
 $ 15.00
Associate Members (60 yrs + & Students over 16)
 $ 5.00
Corporate Members (Businesses Only)
 $ 50.00
Life Members
 $100.00
Perpetual Members
 $ 5,000.00
Date .......................... Reciept No........................ Please Tick If Reciept Is Not Required

Payment Method
Cheque Enclosed Credit Card
Visa Mastercard
Card Number Expiry Date Signature .............................

Subscription Includes Quarterly Newsletter
Subscription Year Runs From January To December