Simian Society of America, Inc.

SOCIETY OF AMERICA, INC.

Application for Membership/Renewal

Please fill out completely in consideration for membership or renewal.    

New _____ Renewal _____

______    Active Membership [Available to those who currently own or have owned and cared for nonhuman primates                    at the discretion of the Board.] (“Caring” shall be defined as providing housing on your premises, SIMIAN                        feeding, maintenance, and veterinary care of captive non-human primates.) 

______    Associate Membership [Available to those who do not currently own and care for a nonhuman primate at their

premises but have an interest in nonhuman primates and wish to support the organization and its purposes                    and objectives at the discretion of the Board.]

CLASSES OF MEMBERSHIP

Individual Membership:  $40.00

Spouse: (Same address/no publication.)  May be purchased only in conjunction with an individual active membership: $10.00 (Husband, wife or life-partner ONLY)

Life Membership* (active membership only) $750.00

(*Life memberships may not be transferred to another person and are non-refundable.)

Membership is renewed each July. New members joining January – June, pay for a full year PLUS the prorated amount of the remainder of the year.

OUTSIDE USA: Please add $25.00 Canadian, $45.00 foreign mailing.  Dues must be in USA currency. Allow four to six weeks for first delivery.

All dues and foreign postage are prorated to renew each July.

* Applicants meeting one of these criteria may be issued an active membership at the discretion of the Board.       

  Memberships will be reviewed each year.

Additional donations may be made to the following funds:

PHN (Primate Health Network) $__________    LHPP (Lu Hall Primate Placement) $__________________

Legislation $_________ General Fund $______________ Education Department $___________________

Publications $____________________  In Honor or Memory of  $______ Name _____________________

PLEASE PRINT CLEARLY. All information you provide will remain confidential.

NAME ___________________________________SPOUSE _____________________________________

ADDRESS _____________________________________________________________________________

CITY _____________________________________________ STATE __________ ZIP ________________

PHONE (H) __________________________________  (W) _________________(C) __________________

FAX (H) __________________________________________ (W) __________________________________

EMAIL ADDRESS ________________________________________________________________________

Occupation______________________________________________________________________________

Are you a member of an SSA Chapter?

Designated Home Chapter   __________________   Member of other Chapters, which ones?  ____________

References of current SSA Members (2)

Name: ________________________________  Name _________________________________________

Email:  ________________________________ Email: _________________________________________

Phone: ________________________________ Phone: _________________________________________ 

The questions below are required to be answered in consideration of membership:

1. Do you currently own and care for nonhuman primates? (“Caring” shall be defined as

providing housing on your premises, feeding, maintenance, and veterinary care of

captive non-human primates.)                         Yes     No

2. Have you previously owned and cared for or have a direct working relationship with a nonhuman primate? 

Yes     No

Please list below primates in your care (species, name, age, sex, year of birth, or DOB if known

 __________________________________________________________________________________

___________________________________________________________________________________

___________________________________________________________________________________

Please list the Veterinarian, including full address, phone number and email address that cares for your primates. 

____________________________________________________________________________________

Are you involved in or a member of, or affiliated with any individual, group or organization that is working to create bans of private ownership of nonhuman primates?                                              Yes    No

If yes, please explain in detail. If not enough room please write on addition paper.

_____________________________________________________________________________________

I declare that I have reviewed all information on this application and have answered all questions truthfully and correctly. I understand that the SSA reserves the right to refuse or revoke my membership at any time according to the bylaws. I have read and agree to the terms of membership.

Signed: ________________________________________________ Date: ___________________________

Enclosed please find my check in the amount of $ ______________, payable to the Simian Society of America; Inc. Membership may be paid through PayPal.  If using PayPal, there is a $2 processing fee.  Your Application or Renewal MUST be emailed or sent to the Membership Chairman with the PayPal proof of payment for your membership to be renewed.

PayPal email is:

simiansociety@yahoo.com

Mail application & payment to

Joseph Hughes

1624 Windsong Forest Road

Clover, SC. 29710

704-898-3012

simiansociety@yahoo.com