Membership Application _____________________________________________ Name _____________________________________________ Address _____________________________________________ City _____________________________________________ State                       Zip _____________________________________________ E-mail Address _____________________________________________ Phone I would like to join Partners for Paws - Please mark your benefit level (Allow 6 – 8 weeks for delivery of your logo merchandise) □ $500 – Best in Show     Circle one:  Fleece Sweatshirt  Windbreaker     Circle size:  S  M  L  XL  2XL □ $250 – Top Dog □ $100 – Tom Cat □ $50 – Pet Pal □ $25 – Helping Paw □ $15 – Tail Waggin’ Junior Membership     Circle one:   Puppy    Kitten Payment Options □ Enclosed is a check payable to:     St. Charles Humane Society □ Please charge my credit card: _____________________________________________ Credit Card # _____________________________________________ Expiration Date                 Security Code _____________________________________________ Name on Card (please print) _____________________________________________ Signature Please detach and mail to: St. Charles Humane Society Partners for Paws 1099 Pralle Lane St. Charles, MO  63303