P O Box 190

Road Town, Tortola

British Virgin Islands
Tel (1) 284 494 2284
Fax (1) 284 494 9008
Email: 
humane@surfbvi.com
Web Site: www.bvihumanesociety.org

MEMBERSHIP FORM

Please print this form out and send it to the above address with your payment or donation.

Membership year is Jan 1st - Dec 31st

Name: ____________________________________________________________

Address __________________________________________________________ ___________________________________________________________________

Telephone: Home ___________________ Work __________________________Fax ____________________

email ______________________________________

Membership for the Year 2006

__/ Renewal_________ __/ New

__/ Standard ($75)____ __/ Corporate ($250)

__/ Sponsor ($150)_____ __/ Donation ($___________)

Please return this form with above information completed so that we can update our data base, and enclose your cheque for the relevant amount, made payable to The Humane Society of BVI

Amount enclosed _________________ Date ________________________

Membership fees assist with the ever increasing overhead expenses of running the animal shelter.