Membership Application Form

Please print this form, fill it out and send to: Pet Owners Alliance 3395 N.W. 37 Ave. Fort Lauderdale, FL 33309

Applicant Information

Name: _____________________________________________ Address: _____________________________________________ City: _____________________________________________ State or Province: ______________________ Zip Code:__________ Number & Breed of Pets _____________________________________________ NOTE: We will send you a registration form for complete descriptions of your pets. Phones: Res./Bus. _____________________________________________ Emergency or Friends _____________________ E-Mail: _____________________________________________ Payment Information

________Money Order _______Check Amount: $_________

Alliance Registration & Membership Fees One Time Fees: We can apply your pet's tattoo and insert the microchip - - Total cost = $48.00 If your pet has a tattoo and all you need is the microchip - Total cost - $20.00 If your pet has a microchip and you need the tattoo only - - Total cost - $28.00 Add National Registration: Computer listing of your pet's Identification. For the first year costs - $19.00 Any additional pets registered at the same time - For the first year costs - $9.00 After the first year the total ANNUAL cost for registering ALL pets is only - $9.00 Contributing Membership: If you do not have pets but would like to support our Animal Rescue work and help with the cost of cruelty investigations, the Annual membership fee is - - - $25.00 Your membership does count and your help is very much appreciated. | BACK | Pets 911 is a service of The North American Pet Owners Alliance Inc., Fort Lauderdale, FL Copyright © 1998-2006 NAPOA, Inc.  All Rights Reserved.