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Humane Society of Washington County Membership Application Date_________________ Name__________________________________________________________________________________________ Address________________________________________________________________________________________ City___________________________________________________ State________ Zip__________ Phone_________________________ Cell Phone________________________ Email___________________________ Enclosed: Membership $10.00 per person____________ Donation Amount __________ In memory of _________________________________ The Humane Society of Washington County is a 501 c3 non-profit organization. All donations are tax deductable. Mail to: Humane Society of Washington County P.O. Box 51 Salem, IN 47167
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