On-Line Scholarship Form

 

Please complete the following form to be considered for ATN’s Scholarship Program, which reduces your annual membership dues from $35 to $20, due to personal hardship. The information you provide us on this form will be held in the utmost of privacy in adherence with our privacy policy.
 

 You can read our privacy policy <here>

If you are a professional, requesting dues assistance, please contact our Membership Director at membership@radzebra.org.

    1. *Name:
    2. Address
      Street_ Address
      Address (cont.)
      City
      State/Province
      Zip/Postal Code
      Country
    3. Phone (optional)
    4. *Email

    5. * Yahoogroups login

     6.  I am applying for a scholarship to reduce my ATN annual

          membership to $20 for the following reason(s) (100 words or less)

         

    7.  Recognizing that ATN is powered by volunteers, I’m willing to  contribute to ATN in the following ways (check all that apply):

      As a local contact to help others in my area find resources and support.

      Actively participating in an online community.

      Moderating an online community.

      Writing for Hoofbeats newsletter, our website or other.

      Staffing our crisis phone or email lines.

      Administrative assistance (mailings, phone calls, database).

       Helping with PR and public awareness.

       Advocacy efforts.

       Soliciting donors and assisting with fundraising efforts.

       Other  .

     

    Once you’ve received confirmation of your scholarship, please complete and submit a membership form and payment, click here.

    After submitting this form, please print out your submissions for your records. Thanks.

    If you have any questions about scholarships, contact us at membership@radzebra.org
     

    
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