ICAW Membership Application - Indiana Council For Animal Welfare

INDIANA COUNCIL FOR ANIMAL WELFARE


	ICAW Membership Application
	Name* First Name Last Name
	Address* City State Zip Code
	Phone*
	Email*
	Type of Membership* Individual Membership - $35 + $5 per dog Business Membership - $100 + $5 per employee Association Membership - $100
	Brief description of Business or Association
	Number of Dogs you Own
	Number of Employees
	Annual Membership Fee per dog or employee $
	Individual Membership
	Business Membership
	Total Annual Membership* $ Calculate Your Total Membership Cost
	Donation $ Would you like to make an additional donation?
	Total Fee* $ Membership Fee + Optional Donation