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Friend of LCHS Application

Please read all of the steps below and then proceed to utilize the on-line application:

1. Please select the desired level of Friend in the drop down box.

2. Then click the “Pay Now” button and enter your info for a credit card purchase, either credit card or PayPal.

3. When payment is complete, in the middle of the payment thank you page, click on “Return to Leavenworth County Humane Society” link, which will return you to the LCHS website. You must then complete the application form below.

4.  Complete the application fields, click send, and the acknowledgement of it being sent will be noted at the bottom of the page.

2010 Friend of LCHS

Please check one:
 Individual $25 Family $60 Supporter $125 Advocate $250 Champion $500 Benefactor $1000 Youth (<18) $15 Senior (>60) $15

Your Name (required)

Address (required)

City, State, Zip (required)

Home Phone (required)

Cell Phone

Your email:

Your Occupation:

Number & type of pets you own:

My regular Veterinarian is:

Do you have particular talents you are willing to volunteer to provide for LCHS?
 Construction Accounting Public Speaking Veterinary training (RVT, DVM) Legal Public relations /advertsing Dog Training

Other Talent than above to volunteer?

I'd like to help LCHS with these efforts:
 Adoption Events Advocacy Facebook Fostering Fund raising Humane Education Newsletter Outreach Photography Publicity Spay/Neuter Transports

I would like to receive information about planned giving (wills).
 Yes No

By clicking on the Send Button I am electronically affixing my signature to this application.