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Membership Application
Select date (*)
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Is this an "Initial" Application or a "Renewal"? (*)
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If this is an "Initial" Application please submit all fields. If this is "Renewal" please fill out all fields on Page 2 and any information that has changed on Page 3.
   
Please select type of membership (*)





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Name (*)
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If this is a family/household membership, please list all other members of the household separated by a comma
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Street: (*)
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City: (*)
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Zip: (*)
Please enter your 5 digit zip code (i.e. 48642)
Home Phone:
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Cell Phone:
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Work Phone
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Email Address
Please enter a valid email address
Employer
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Are you 18 of age or older? (*)
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Have you or anyone in your household ever been convicted of animal cruelty and/or neglect? (*)
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(For family/household memberships only!) If there is anyone in your household that is over 18 and may wish to vote, please list their name and age in the box below
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Indicate any experience with animal welfare or rescue and where and how you worked/volunteered
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The animals in your life:
How many dogs do you own? (*)
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How many Cats do you own? (*)
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How many other pets do you own (rabbits, horses, guinea pigs, etc.)? (*)
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Are all of your pets spayed/neutered?
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If no, please indicate reason(s):
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Are your pets up to date with all of their preventative and/or immunizations?
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If no, please indicate reason(s):
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Volunteer Activities:
Foster Guardians:
Please indicate if you are interested in Fostering any of these type of animals
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Foster and Adoption Team Assistant:
Please indicate if you are interested in helping with any of the following




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Shelter Volunteering:









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Outreach:




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Fundraising and Events:




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Communications and Administrative:








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Please list anything that you would like to help us with that was not listed here.
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Additional donations along with your membership fee would be greatly appreciated but not mandatory. Members who join on or after October 1 are current on dues through the following year.
The privilege of voting is granted to all members in good standing. Details of voting privileges are outlined in the by-laws and sent to members prior to elections. A member in good standing (dues are current, has not been convicted of cruelty to animals, is not under investigation for possible termination of membership) may attend Membership and open Board meetings and events, apply for fostering, and enjoy other member privileges.
I (We) will remember that I (We) am a representative of the Humane Society of Midland County and shall abide by HSoMC guidelines & policies and will make every effort to promote the mission of HSoMC. Failure to do so could result in termination of membership.
I (We) grant to HSoMC, its representatives, and employees the right to take and use photographs of me (us). I (We) authorize HSoMC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I (We) agree that HSoMC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising and Web content.
I (We) understand that information/documents developed or used to support HSoMC and its activities are the property of HSoMC.
I (We) have completed this application to the best of my (our) ability and knowledge and have made no misstatements or misrepresentations.
Signature (*)
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Date (*)
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By typing your name in the signature box this acts as your legal signature. If this is a minor, the parent/guardian must sign for them.
AFTER YOU HIT THE SUBMIT BUTTON, YOU WILL BE DIRECTED TO THE PAYPAL WEBSITE TO PAY YOUR DUES. YOU WILL NOT BE CONSIDERED A MEMBER UNTIL YOUR DUES ARE PAID. Dues are as follows: : Individual $15. Family or household $25. Full time student $10. Senior Citizens 55-69 $10, Senior citizen age 70 and over FREE. Lifetime membership (Individual or family) $500
Please indicate in the purpose field that this is "MEMBERSHIP DUES"