APPLICATION FOR MEMBERSHIP

To: The Company Secretary, The Lost Dogs’ Home, 2 Gracie Street, North Melbourne I hereby apply to be a member of The Lost Dogs' Home. In the event that this application is accepted, I confirm that I agree to be bound by the Company’s Constitution. The Subscription Fee of $10 accompanied this Application and my credit card details have since been removed for the purposes of providing this application with the Board of The Lost Dogs’ Home.

Applicant (print name):

Residential address:

Email address:

Contact phone number:

Name of pet/s:(please indicate if dog or cat)

Why are you interested in becoming a member of the Home?

Please detail any previous involvement with the Home?

Which other interest groups or organisations are you associated with?

Do you support any other charities or not-for-profit organisations? [ ] Yes [ ] NoIf so please specify which charities?

What is most important to you as a supporter of the Home?

What services are most important to you?[ ] Shelter services for lost, stray and surrendered dogs and cats[ ] Reuniting lost pets with their owners[ ] Adoption services for unwanted dogs and cats[ ] Veterinary care for stray, injured, sick, elderly and neglected animals[ ] Behaviour rehabilitation for unwanted dogs who need extra training and

socialising before adoption[ ] Foster care program for underage, injured, ill and rehabilitating animals

needing extra support and care before adoption[ ] National awareness campaigns for responsible pet ownership[ ] MADI – mobile low-cost, desexing service[ ] Pet Licence online test that teaches prospective adopters about

responsible pet ownership

Applicant’s signature Date

To be completed by the CEO and Board of Directors: I confirm that the applicant has paid the subscription fee of $10

Andrew Israel (CEO) Date

Proposer (print name)

Proposer’s signature Date

Seconder (print name)

Seconder’s signature Date

SUBSCRIPTION FEE(to accompany a Member Application Form)

Individual Membership $ 10.00

I would like to include a donation of

$

Total amount enclosed $

[ ]

Please find enclosed a cheque or money order (made payable to The Lost Dogs’ Home)

[ ]

Please find credit card details below

Credit card type

[ ] Visa [ ] Mastercard

[ ] American Express

Name on card

Credit card number / / /

Credit card expiry date

/20

Signature

Thank you for your support.Donations of $2.00 or more are tax deductible.