Date:

Name:

City:

Cell Phone:              

Home Phone:

Email Address:

I would like to help with the following (delete the items you are not interested in):

1) Tabling Events
2) Pet Store Rallies
3) Media
4) Lobbying
5) Pet Store Activism (Launching a new campaign against my local pet store who has not pledged to stop selling puppies.)
6) Sign Making
7) Finding Merchandise & Literature
8) Educating Kids
9) Library Displays
10) Research and creating databases. 
11) Finances (donate to special projects)
12) Special Projects (request current list)
13) Other

Total Hours Available Per Month:

Generally, I am available on (Mon, Tue, Wed, Thur, Fri, Sat, Sun):

Best Time to reach me:

I volunteer/support the following Rescues/Shelters:

I am the guardian of a Puppy Mill Survivor:

Please copy/paste into an email and send to Leroybrown01@yahoo.com

Thank you