Leash-Free Mississauga - Membership Form

Human Information:

Walker 1:First Name: _________________________ Last Name: ______________________

Walker 2:First Name: _________________________ Last Name: ______________________

Street: ______________________________________________________________

City: _________________________ Postal Code: _________________________

Phone: _________________________ Email: _________________________

Dog Information:

Dog 1:Name: _________________________ Breed: ____________________ Sex: ___

Dog 2:Name: _________________________ Breed: ____________________ Sex: ___

Dog 3:Name: _________________________ Breed: ____________________ Sex: ___

Park Information:

Please circle  one of the following parks as your home park. 30% of your annual membership fee goes towards maintenance of your home park, with the remainder going toward repayment of the costs of establishing and maintaining the parks.

Etobicoke Valley      Garnetwood      Jack Darling     Parkway Belt      Quenippenon        Lakeside     Totoredaca (www.totoredaca.org)

Personal Information:

The above information is collected so we can contact you. Your detailed personal information is confidential. We do post a membership list in your home park consisting of your dogs name breed and sex, and your first name. If you do not wish to be included in posted membership list, please checkthe box below.
I understand that I am responsible for my dog’s actions at all times. I am including $10 or $15 (for 2 or more family dogs) as a member fee to Leash-
Free Mississauga. Please make cheques payable to Leash-Free Mississauga and mail it along with this membership form to the address below.

$10, one dog/year           $15 more than 1 dog/year

Do not include me in the posted membership list
Please contact me about voluneering for LFM

Donations are also very gratefully accepted. Donation: $_______________

Signature: __________________________ Date:___________

LFM is a volunteer organization and we need your Help!

Leash-Free Mississauga

PO Box 52541, 1801 Lakeshore Road West, Mississauga, ON L5J 4S6
416.761.POOP (7667), www.caninefriends.com
05/03/04