HHC Membership Application

ORGANIZATIONAL INFORMATION
Name of organization:		Telephone number:
Address:		Fax number:
Address Line 2:		Website address:
City:		General e-mail address:
State:		How did you hear about HHC?
Zip:
CONTACT PERSON
Contact Person's Name:		Contact Person's Phone: (if different from above)
Contact Person's Title:		Contact Person's e-mail: (if different from above)

TYPE OF ORGANIZATION

Is the organization a 501c3 (or the equivalent if operating outside of the US)?

yes
no

We are a (please check the radio button and then fill out the fields below your choice):

a. Equine Advocacy Organization

Year in which the organization was established:

b. Equine Rescue/Retirement Organization

Year in which the organization was established:
Has the organization ever been the subject of an animal cruelty or neglect investigation?	yes no
Does the organization have a policy in place to ensure that the rescue is notified by the adopter and given first right of refusal to take possession of a horse if the adoption is unsuccessful?	yes no
Does the organization have a policy against breeding of the animals it cares for?	yes no
Is humane euthanasia used only as a last resort (and not as a general management tool)?	yes no

REFERENCES (for Equine Rescue/Retirement Organizations)
Please list four refences (these may include organization's regular veterinarian and/or farrier, and one should be a personal/family reference):
Reference 1
Name:		Title:
Relationship to organization:		Phone:
Email:
Reference 2
Name:		Title:
Relationship to organization:		Phone:
Email:
Reference 3
Name:		Title:
Relationship to organization:		Phone:
Email:
Reference 4
Name:		Title:
Relationship to organization:		Phone:
Email:
Yes, we wish to register for voluntary compliance with the AWI/HSUS "Basic Guidelines for Operating an Equine Rescue or Retirement Facility". If yes, please click here to fill out the voluntary compliance form (a separate window will open, and you can complete and submit this form before filling out the compliance form).

c. Law Enforcement Agency/Humane Society/Animal Control Agency

Please give details:

d. Other/Individual Applicant (Note: Individual applicants will be listed as HHC "supporters").

Please give details:

WE'D LIKE TO HEAR FROM YOU

The Homes for Horses Coalition wants to know what type of services you would like HHC to provide its members. Which of the following services would benefit your organization?
Information on fundraising/funding sources/grant writing
Rescue/sanctuary accreditation program
Media training
Access to an emergency equine rescue network
Information on progressive equine trainign techniques
Information on relevant legislation
Other (please describe)

SUPPORTING LEGISLATIVE EFFORTS TO END HORSE SLAUGHTER

Yes, I support the Prevention of Equine Cruelty Act and other legislation to stop horse slaughter and transport of horses for slaughter. You may add my name to the list of supporters! (Support of this legislation is a membership requirement.)

Please type the imaged text in the box provided.