annual membership application ...
basset rescue of old dominion, inc.

Please complete and send, along with your payment for $20 made out to BROOD, as directed at the bottom of this form.

 Mailing Address:
BROOD Membership Coordinator
3445 Seminole Trail, Box 248
Charlottesville, VA 22911

Required fields are indicated in bold with *

Membership:*  New Renewal

First Name(s):*

 

Last Name:*

Address:*
City:*   

State:*

Zip:*

Home Phone:*

 

Work Phone:

Email:*

How many bassets do you currently have?*

Tell us about your bassets
(name, age, was it rescued, etc.)

What are your interests/skills (please check all that apply):

Artistic or Craft Abilities Writing/Editing Photography/Video
Accounting Technical/Computer Dog Training/Evaluation
Veterinary or Vet Tech Fundraising Grants

Entertainment (Food, Social Activities)

Organizational Skills

Other (please specify)

BROOD always needs volunteers!  Would you be willing to help with (please check all that apply):

House Visits Fostering Transporting Dogs
Publicity Follow-up Calls Fundraising Events
Online or Telephone Research Photography/Videography

Other (please specify)

HOW DO YOU PLAN TO PAY THE $20 APPLICATION FEE?*    Check  PayPal

Please SUBMIT your application regardless of payment method selected.
You will have the opportunity to pay with PayPal after you submit the application. 

By submitting this application, I am agreeing that all of the information I have provided on this membership form is, to the best of my knowledge, true and complete.