Completion of this annual questionnaire by each greyhound adopter is required per GPA/Houston's Adoption Application. 

This information is essential for the benefit of you and your greyhounds.

Owner's Name(s)

Street Address

City State Zip

          Check here if this is a new address.

Work Phone (1)   Work Phone (2)  

Cell Phone (1)     Cell Phone (2)

Home Phone

E-Mail Address 

Additional E-Mail Address?

Occupation (1)  

Employer 

Occupation (2)  

Employer 

Do you currently have a greyhound(s) in your home?  Yes     No

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Greyhound's Name  

Age GPA Tag ID

Has your greyhound experienced any health and/or behavioral problems during the past year?  If yes, please provide a brief explanation.

Who is your Veterinarian?  

Address  

Phone

What is the brand name of heartworm preventative your greyhound receives?

I am renewing my GPA/Houston Membership for: 2012*

(*If you adopt after October 2011, your dues are paid for 2012)

I am a new Member.

Levels of Membership:

 As a member I would like to help the greyhounds by:

Other: Please list any special skills (professional or hobbies) that you have that you would be willing to share with GPA Houston.

I am including a tax deductible donation in the amount of $
Please apply this donation to:

My employer offers a Matching Gift Program.  Please contact me at

Method of Payment       Check    (Please submit the form then mail a copy along with your check to the GPA Office.)
                                                         Membership Renewal
                                                         GPA/Houston
                                                         P.O. Box 741176
                                                         Houston, TX  77274

                                      Credit Card :   Visa       MasterCard

You may pay with your credit card through our PayPal account.  After submitting this form, click on the Paypal button that appears on the next page.

Thank-you!

GPA Houston would like to acknowledge members who donate to our organization on our website.

Do we have permission to post your name on our website and/or our newsletter?

  Yes   No