LAPP Membership


	2010 LAPP Membership Application/Renewal

Human name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
email:


	Please list any of your current registered Pet Partners

Name
Species
Delta Expiration
Predictable or Complex
Visiting Preferences


	Name, species and age of animals in training as Pet Partners:


	Activities and events most interested in supporting (Pet Partner or other):


	If you are a Pet Partner, would you like to have a mentor assigned to help you get started volunteering?


	Yes


	No


	Already have one


	If you already have a mentor, who is it?


	LAPP shirts (purple polo shirts with LAPP’s logo in white) are required at all AAA/AAT events. Do you wish to purchase one at this time? Yes No


	If so, what size? (men’s sizing) Quantity

Annual Membership:
Lapp Shirt ($12.50 each):
Total Due:

After hitting the Submit button you will be taken to PayPal where you can pay with your PayPal account or with a credit card. If you do not pay within an hour this application will not be valid.

PLEASE NOTE: you will need to know the "Total Due" amount before proceeding so you can enter it into the Paypal page. You are not registered until you hit the submit button AND send full payment via the PayPal website.


	[LAPP Membership]