Is this a correction, update or a new entry?*

Select One Update 2010 New 2010

Organization's FULL Name*:

Counties your group serves*

Select All NC Counties Alamance Alexander Alleghany Anson Ashe Avery Beaufort Bertie Bladen Brunswick Buncombe Burke Cabarrus Caldwell Camden Carteret Caswell Catawba Chatham Cherokee Chowen Clay Cleveland Columbus Craven Cumberland Currituck Dare Davidson Davie Duplin Durham Edgcombe Forsyth Franklin Gaston Gates Graham Granville Greene Guilford Halifax Harnett Haywood Henderson Hertford Hoke Hyde Iredell Jackson Johnston Jones Lee Lenoir Lincoln Macon Madison Martin McDowell Mecklenburg Mitchell Montgomery Moore Nash New Hanover Northampton Onslow Orange Pamlico Pasquotank Pender Perquimans Person Pitt Polk Randolph Richmond Robeson Rockingham Rowan Rutherford Sampson Scotland Stanly Stokes Surry Swain Transylvania Tyrell Union Vance Wake Warren Washington Watauga Wayne Wilkes Wilson Yadkin Yancey

Hold down the Ctrl key while clicking with your mouse to select more then one County

Mailing Address

(the main address where you receive your mail. For example, donations, bills, bank statements etc)

Address*

Suite, Apartment, Building Number

City*

State

NC

Zip Code*

Physical Address

(ONLY if you have a facility! This is where you house your animals if you are a shelter. If you are a foster care system then do not fill this part out)

Street Address

Suite, Apartment, Building Number

City

State

NC

Zip Code

*Phone

(Please use dashes)

FAX

*E-mail

*Website

http://www.

You can put your Petfinder, Pets911, Adopt A Pet or Petango website here if you do not have a main website

What animal do you mainly focus on?* (dogs, cats, etc)

Select One Birds Cats Dogs Feral Cats Horses Reptiles Wildlife Other

Hold down the Ctrl key while clicking with your mouse to select more then one choice

If you chose Other please specify

What services do you provide? *required 

Do you provide: (Check all that apply)

veterinary care

spay/neuter

For spay/neuter do you provide:

- *subsidized or discounted?

             Select One Yes No

-  *available to the public?

             Select One Yes No

And is it:

- *required before adoption?

             Select One Yes No

Do you: (Check all that apply)

respond to community animal-related complaints

shelter unwanted, homeless or stray animals

euthanize unwanted or homeless animals

rescue, foster or provide sanctuary for animals

educate about animal issues

provide animal care/training assistance

support and assistance for animal shelter

traps or assistance with feral cats or strays

other (please explain)

Adoption/Euthanasia numbers *required

To help us create accurate statewide figures we ask that you provide your 2009 info. If you do not euthanize please place zeros in the boxes.

*Intakes:

dogs    cats  

*Adoptions:

dogs    cats  

*Euthanasia's:

dogs    cats