United States Equine Sanctuary & Rescue

Membership Registration Form

 

 

Full Name: ____________________________________________________________________________

 

Type of Membership: 

(All memberships expire after one year)

 

___ Level 1:  Individual Membership  $25.00.   Includes a waiver of filing fees on all adoptions & a

       free subscription to our newsletter.

___ Level 2:  Family Membership  $40.00.  Includes benefits given to all previous levels of

       membership plus a 1-time family profile in our newsletter.

___ Level 3:  Platinum Membership $75.00. Includes benefits given to all previous levels of

       membership plus honorable mention on our website for the duration of Level 3 membership.

___ Level 4:  Gold Membership $175.00.  Includes all benefits given to all pervious levels of

       membership plus up to $50.00 off on adoption fees.  *Up to two equine per calendar year;

       offer applies to primary member and one member of his/her family

Personal Information:

For Family Memberships Only:

Please list the names (1^st & last) & ages of each family member: ______________________________

 

______________________________________________________________________________________

For Corporate Members Only:

What is the name and nature of your company? ___________________________________________

 

______________________________________________________________________________________

 

Primary Member’s age & date of birth: ___________________________________________________

 

Primary Member’s Marital Status: married_______   single________ 2 adult family situation_____

 

Address: _____________________________________________________________________________

 

Home Phone: _______________________________  Work Phone: _____________________________

 

Cell Phone: ________________________________    Pager: (for emergencies only) ______________

 

What is your e-mail address? ___________________________________________________________

 

Do you own any animals?  If so, how many? _________  Any horses? _________________________

 

If requested, could you furnish at least 3 character references? _______________________________

 

Have you ever been investigated for any sort of abuse (human or animal)? ____________________

 

How did you hear about USESR? ________________________________________________________

 

 

 

 

 

 

Are you now or have you ever been a member of another horse rescue organization? ___________

 

If yes, which one? _____________________________________________________________________

 

 

Would you like to receive your newsletter?

                (Please check one)

                Via U.S. mail ___________

                Via e-mail __________

               

As a member of the United States Equine Sanctuary & Rescue, you may be subscribed to our Members Only

e-mail list.  Membership to this list is a privilege subscribers can use to learn details of future issues to be voted on, among other things.  Please let us know what form of subscription you would like to have:

(Please check one)

                Regular (receive each message as it is posted to the list) _________

                Daily Digest (receive one single e-mail from the list each day, containing a numbered list of subject titles sent to the list that day.  When you find a subject you are interested in, you simply scroll down to that message and read it.  *Note: not all messages will be in displayable format in digest version, so you will not be able to read every post) ____________

                Please do not subscribe me; I plan to be inactive _____________

 

May we have your permission to distribute your mailing address & phone number to our members in a membership directory? ______________

 

Are you interested in actively volunteering?  _____________________________________________

 

If so, approximately how many hours per week can you volunteer? _________________________

 

Note:  All new members will be voted in at the USESR meeting immediately following the month you submit your membership registration and dues.  You will be a member from the time you submit this form, along with your dues.  You may be subscribed to our private e-mail list, allowed to participate in all USESR functions, but you will not be allowed to vote until you have been voted in.  The voting in of new members is merely a formality.

 

The United States Equine Sanctuary & Rescue thanks you for your interest in this organization.

Please make checks payable to United States Equine Sanctuary & Rescue and mail to:

P.O. Box 565 Bridgeport, TX  76426

 

A word about equine rescue:

Your ongoing support is vital to our ability to continue to advance our purpose.   We appreciate your membership, however, inactive members who do not contribute physically or monetarily are not what the horses need.  Everyone leads a busy life.  Most juggle work, family, outside interests and activities.  We hope that you will be at least somewhat active and will care about the organization for the sake of its mission.  On behalf of the equine, we want you to know that we appreciate any activity you can give.

 

If you plan to volunteer, please fill out our volunteer registration form and enclose it along with this membership registration form.

 

Thank you for caring!