100% Stainless Steel Guardian Collar Tag

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Guardian Collar Tag New Membership Activation - Additional Pet

Who should use this form

This form may be used to activate your additional pet in the Guardian program:

Tell us about your pet!

Your Current Membership Number (this is the ID number from your initial pet).
If you do not have your Membership Number, please call member services at 800-272-7387.		 (i.e. - 1234H)
Have you been issued a tag for this pet?  If so, enter the ID number here. (i.e. - 1234H)
Where did you get this pet?
Pet's Name
Breed (i.e. - Labrador, or Mixed - Lab/Shepherd, or DSH (Domestic Short Hair) ect.
Choose one of the following options:
Choose one of the following options:
Age and/or birth date
Coloration
Markings (A very good visual description is necessary, include scars, and any other noticeable markings.  If none, enter "none")
Choose one of the following options:
Medical Information - Is your pet taking any life sustaining medication?
Your Veterinarian and Facility Name
Their Phone Number

 

Your name: First                                            Last
Email Address:
This is where your activation code will be sent.
Work Phone#:   Home Phone 123-123-1234

Select a Membership Option

This special lifetime conversion offer is made only to humane center adoptees and only at the time of activation as a way of thanking you for adopting your pet from your humane agency. You have helped save the life of a forgotten friend, and reduce the pet overpopulation problem and for that we thank you.

Membership Options Qty Price
Guardian One Year Membership included with your adoption.  Please enter the ID Number from the Guardian Tag given to you by the humane agency.

You will be sent a renewal reminder at the end of your first year for only $12.95/year.

 $ 0.00
Guardian One Year Membership for a pet that was not adopted from an APA Associated Facility.

 

 $12.95
Guardian Lifetime Additional Pet (Only if you have a current lifetime membership)

$10.00

Payment Information (if applicable)

Credit card information
Card type:
Card number: e.g.: 1234-5678-9012-0000
Expiration: e.g.: 09/05
Cardholder name:

APA Member Services
Copyright © 2001- 2003 American Pet Association. All rights reserved.
Revised: 11/05/08.