Please print this form twice. Once for yourself and another for a friend. We genuinely appreciate your contribution! If the homeless animals could speak, they would express their gratitude monumentally.
Name_________________________________________________________________________________
Address_______________________________________________________________________________
City________________________State_______________________Zip_____________________________
Phone______________________________________FAX_______________________________________
| Benefactor $1000 - ( ) | Life Member $500 - ( ) |
| Patron $200 - ( ) | Sustaining $100 - ( ) |
| Family $30 - ( ) | Individual $15 - ( ) |
Mail To:
Humane Society of Polk County, Inc.
555 Sage Road - Winter Haven, Florida 33881