Collie Rescue Foundation Membership

To join Collie Rescue Foundation, please complete this form and mail it to the contact listed below.

Type of Membership (check one) :
        __ Single Collie    $25
        __ Pair of Collies Family    $40
        __ Serious Supporter of Rescue    $100
        __ Wild About Rescue    $500
        __ Totally Crazy Over Rescue    $1000
Memorial/Tribute Donation    __________   In (check one) __ Memory / __ Tribute of:
____________________________________________________________________________________
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Name:	_________________________________________________________________
Address:	_________________________________________________________________
City, State, Zip:	_________________________________________________________________
Phone:	_________________________________________________________________
E-Mail:	_________________________________________________________________

Please send payment via Check or Money Order U.S. Funds payable to Collie Rescue Foundation to:
Annette Miller
1515 Timber Ridge Road
Bedford, Virginia 24523

The Collie Rescue Foundation thanks you for your support!