From this point on, any business or individual signing this form is termed “member.” A membership term is dated from the time of payment for the number of years specified.  For instance, if you sign and pay the initial membership form on July 4, 2009, your membership is in force from that date until July 4, 2011. Renewal fees are for extended time frames, at a reduced yearly cost.

I hereby agree to adhere the rules and by-laws set down by the Hiway Dog Program.  The goal is to provide a safe stop, shaded parking and designated potty location. More amenities are encouraged and each business can customize the program according to locale. I understand that the Hiway Dog program offers only a promotional service.

By signing this form you indicate that you agree and understand the following:

• Members are permitted limited use of the Hiway Dog logo on in-house promotions.
• Members must purchase the necessary exterior metal Hiway Dog signs.
• Membership enrollment is for a specified time period.
• Members will provide and maintain a determined level of pet amenities.
• Members can not hold Hiway Dog responsible for any losses or injuries sustained on member premises, or as a result from sponsored events. Member further agrees to idemnify and hold Hiway Dog harmless from any claims or demands rising out of such claims or losses.
• The Hiway Dog symbol will not be used in a means that is derrogatory or harmful to the program or other participants in the program
• Any assistance and support from members, that has a positive affect on animal rescue or humane organizations, will be applauded and encouraged by this program.
• Member membership status can be revoked or suspended if these rules are broken, or standards not met.
• Members agree to allow photographs or videos to be taken on their premises, to be used for marketing applications promoting the Hiway Dog program.

I authorize my bank to release the amount on my authorized check to Hiway Dog, for the membership term indicated below.

Choose appropriate fee for initial TWO YEAR MEMBERSHIP. 
         Only one address or location per membership, unless otherwise negotiated with Hiway Dog.

• Supporter: $150 Gold star on sign rather than “bones”. For members who do not directly benefit from increased customer base, but wants to support the community/program.  This includes, but not limited to civic clubs, chambers of commerces, etc.
• Business with 1-20 Employees: $250 
• Business with 21-50 Employees: $500
• Business with 50+  Employees: $1,200

Business/Member Name: ________________________________

Location: _____________________________________________

Billing/Contact Address: _________________________________

City: ___________________  State: _______  Zip: ____________

Email: ___________________   Contact Person: ______________

Date:  ___________________   Signature:   __________________


YOU MAY PRINT OUT THIS FORM and mail to:
Hiway Dog
2655 Hwy 8
Cameron, WI  54822

A representative will contact you, asking for number of signs needed and how to provide payment.  Sign costs are based on the size of signs you require. Call for specific prices for your needs.