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        Animal Compassion Network Membership Application
              "Joining Paws Across The Mountains"

                          Mail to: 
   Animal Compassion Network, PO Box 1704, Skyland, NC 28776
Name ___________________________________ E-Mail _________________
Home Phone (with area code) _______________ Other # _____________
Fax# _________________________ Best time to call: _____________
Mailing address ___________________________________________
City _______________________ State ______ zip code ____________ 
Method of payment	__ Money order	__ Check	__ PayPal
__Please save postage and send me future newsletters via email
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              TYPE OF MEMBERSHIP (Check one or more)
If gift membership, please also fill out section at bottom of form
__ Individual (one person)                                 $15.00
__ Family (Related persons living in the same household)   $25.00
__ Sponsor                                                 $50.00
__ Benefactor                                             $100.00
__ Corporate                                              $250.00
__ Patron                                               $1,000.00
__ Founder                                              $2,500.00
__ Additional Donation                                  $________
                                         ========================
(Make check or money order to "ACN".)    TOTAL ENCLOSED: ________

ACN is designated as a 501(c) 3 non-profit.
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                     Volunteer Opportunities
              (check all that you are interested in)
__ Providing foster animal home  __ Education
__ Pet Placement                 __ Special Needs Rehab
__ Pet Therapy                   __ Fundraising/Special Events
__ Animal Training               __ Legal advocacy for animals
__ Pet Grooming                  __ Public Speaking/public
__ Donating Supplies (leashes,       relations
    collars, carrier crates,     __ Other _____________________
    office supplies, etc.)
Upon receipt of your application, an ACN representative will
contact you to discuss volunteer opportunities you checked in
detail. 
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__Please acknowledge my Gift Membership to:
Name ___________________ Address _______________________________
City ________________ State __________ Zip _____________
Phone __________________Email ________________________
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           Thank you in advance for your contribution.