Columbia County Humane Society

Annual Membership Application

January 1 - December 31

Pick your membership level:
_____  $5 Pet
_____  $10 Sr. Citizen
_____  $15 Individual
_____  $25 Family
_____  $50 Patron
_____  $100 Benefactor

Name:________________________________
Address:________________________________
City/State/Zip:________________________________
Phone:________________________________
email:________________________________

____  Add my email address to your mailing list

____  Send me a volunteer application

Make checks payable to: CCHS

Mail application and membership fee to:

CCHS Membership Application
N7768 Industrial Road
Portage, WI 53901-9451