The Fund for Animals Donation Form

Name(s) ______________________________________

Address (1st line) _______________________________

Address (2nd line) ______________________________

City _________________________________________

State/Province _________________________________

Zip or country code _____________________________

Country ______________________________________

Home phone (_____)____________________________

• ___ Student Membership ($10.00)
• ___ Adult Membership ($20.00)
• ___ Family Membership ($35.00)
• ___ Special Membership ($50.00)
• ___ Extra-Special Membership ($100.00)
• ___ V.I.P. -- Very Important Patron ($1,000.00)
• ___ Life Membership ($5,000.00)

Please print, fill out, and mail this form with payment to:

The Fund for Animals
200 West 57th Street
New York, N.Y. 10019, U.S.A.