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First Name __________________________ Last Name_____________________________
Address___________________________________ Box/ Apt __________
City ______________________ State __________ Zip__________
Phone _____________________ Work Phone (optional) ____________________
Email Address _________________________________________________
Would you prefer to receive our newsletter, "Ghost Talk", via mail _____ or email _____?
Single Membership $15 (one vote) ________ or
Family Membership $20 (two votes) ________
Donation to the local rescue fund (optional): ________
Have you or any member of your family ever been convicted of animal
abuse/cruelty? If so explain.
What areas are your interest in? Check as many as applicable.
Pet _______ Confirmation _______ Field Trial _______ Hunt Test________
Obedience ________ Agility ________ Other (list) _____________________
Please PRINT this page and send it and a check payable to MHWC:
MHWC
P.O. Box 1220
Brighton, CO 80602
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