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HAR Membership Form
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HAR Membership Form
Please select from the following:
*
I am joining as a new member
I am renewing my existing membership
Name
First
Last
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Phone
*
Email
*
Consent
*
I hereby apply to become a member of the above association. In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force. Also, forfeiting an Annual Membership Fee as below.
Membership period
*
1 Year membership ($10.00)
3 Year membership ($25.00)
5 Year membership ($40.00)
Please select which of the following (if any) apply to you
I am a Foster Carer with HAR
I am a registered Volunteer with HAR
I am a Position Holder with HAR
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Donation Amount
*
Name
*
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Last
Email
*
Phone
Billing Address
*
Street Address
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Credit Card
*
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Card Number
Month
01
02
03
04
05
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07
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Year
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2044
Expiration Date
Security Code
Cardholder Name
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