MWAC Membership Application

To apply online using your credit card: Fill out the application form below and click the submit button, view your submitted information and click the link to MWAC's payment instruction page to pay using MWAC's PayPal service. (You DO NOT need a PayPal account to use this service)

To apply by mail, and pay with a check : FILL OUT THE APPLICATION ONLINE, DO NOT PRESS THE SUBMIT BUTTON, instead: print the filled out form and mail it to: MWAC, P.O. Box 130545, Roseville, MN, 55113 along with your check for $20.00 made out to MWAC.

 

First name M.I. Last name or

Name of organization

Street address

City State Zip code

Phone Mobile Email

Are you a Wildlife Rehabilitator? Yes No

If Yes, what is your level?

What animals do you work with:

Your state permit number is:
     

Your federal permit number is:

     

If No, would you like to become a licensed wildlife rehabilitator Yes No

What are your other Interests:

New member

renewing member

 

   

Annual membership fee: $20.00