P.O. Box 787
Locust Grove, GA 30248
Phone: 770-464-0138
FAX: 770-265-5043
Membership Application
This is a: Renewal ___________________ New
Membership ________________________
Name:
_______________________________________________________________________
Address:
_____________________________________________________________________
City, State, Zip:
__________________________________ County:
_______________________
Phone: Home_________________ Work
_____________________Fax ____________________
Email Address: ____________________________
Referred By: __________________________
Please check all that apply:
________________ I am a horse owner.
________________ I do not own a horse, but I would
like to support GERL.
________________ I am interested in becoming a GERL
Foster Home.
________________ I am interested in becoming a GERL
volunteer
Donations:
________________ $35.00 Family Membership
________________ $25.00 Single Membership
________________ $15.00 Junior Membership (age 11 or
under) Age: ________________
________________ $50.00 Club, Organization, Business
Membership
________________ $1000 Lifetime Membership
________________ Miscellaneous Donation/Sponsorship
of a horse in foster care