Headwaters Animal Shelter Membership Application Adopt a PetDonate Headwaters Animal Shelter Membership Application FormUse this form to apply for a membership at the Headwaters Animal shelter. We accept payment via PayPal; or you can mail a check to: Headwaters Animal Shelter P.O. Box 573 Park Rapids, MN 56470 We appreciate your support!Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 2Applicant InformationYour information will be stored in our website files, but will only be available to select shelter staff.Name *FirstLastEmail *Mobile Phone *Home PhoneHow do you prefer to be contacted? (Select all that apply) *EmailPhoneText messageAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNextMembership fees are due at the beginning of June of each year. As a Headwaters Animal Shelter member, you will receive our quarterly newsletter, special invitations, and mailings. Cost for membership: Individual: $25.00 Family: 35.00 Corporate: $250.00 Lifetime: $500.00 Membership Type *New MembershipRenewalAre you a new member, or are you renewing your membership to Headwaters Animal Shelter?Payment Method *PayPal (You do not need a PayPal account. Simply choose "Credit Card" in the selection box.)Mail a CheckMail your check to: Headwaters Animal Shelter P.O. Box 573 Park Rapids, MN 56470Multiple Items *Individual - $25.00Family - $35.00Corporate - $250.00Lifetime - $500.00PayPal Commerce *PayPal CheckoutCredit CardCard NumberExpiration DateSecurity CodeCard Holder NameUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.Custom Captcha *What is 7+4? PreviousSubmit12215 Browse Our Available Pets Follow Headwaters Animal Shelter on Social Media FollowFollowFollowFollowFollow
