MEMBERSHIP FORM

Membership Registration Form

Full Name: ___________________________________________________

Type of Annual Membership: (All memberships expire after one year)

___ Level 1: Individual Membership $25.00

___ Level 2: Family Membership $40.00

___ Level 3: Platinum Membership $75.00

___ Level 4: Gold Membership $175.00

For Family Memberships Only:

Please list the names (1st and last) and ages of each family member: _____________________________________________________________

_____________________________________________________________

Primary Member’s Age and Date of Birth: _____________________________________________________________

Address: _____________________________________________________

Home Phone: __________________ Work Phone: __________________

Cell Phone: ____________________ Pager: (emergencies only) __________

What is your e-mail address? ________________________________________________________________

Do you own any animals? If so, how many? _________ What type of animal(s)?

__________________________________________________________________

If requested, could you furnish at least 3 character references?

___________________________________________________________________

Have you ever been investigated for any sort of abuse (human or animal)?

____________________________________________________________________

How did you hear about Angels Haven?

_____________________________________________________________________

Are you now or have you ever been a member of another horse rescue organization?

If yes, which one(s)? _____________________________________________________________________

If yes, do you volunteer your time? _____________________________________

If yes, in what ways? __________________________________________________

Please print out this form and mail along with your check payable to : Angels Haven Horse Rescue and send it to the following address:

Angels Haven Horse Rescue

Mindy Kazaroff

21140 Robinhood Avenue

Fairview Park, Ohio44126

We appreciate you caring and helping us with our mission of rescuing neglected, abused and unwanted horses…. And providing a life for them that they deserve!