NAME:___________________________________________________________________

SPOUSE:__________________________________________________________________

ADDRESS:________________________________________________________________

CITY/STATE/ZIP:___________________________________________________________

PHONE(area code) :_________________ NUMBER:_______________________________

EMAIL ADDRESS:__________________________________________________________

CHILDREN(IF MEMBER):____________________________________________________

ARBA#____________________________SPOUSE#______________________________

CHILDREN#_______________________________________________________________

RABBITRY NAME:__________________________________________________________

BREEDS RAISED:___________________________________________________________

PLEASE CIRCLE ONE: NEW RENEWAL

TYPE OF MEMBERSHIP (CHECK ONE)

ONE YEAR THREE YEARS

INDIVIDUAL (ADULT) $ 5.00 (_____) $ 12.00 (_____)

HUSBAND / WIFE $ 7.50 (_____) $ 20.00 (_____)

FAMILY $12.00(_____) $ 30.00 (_____)

YOUTH (UNDER 18) $ 3.00 (_____) $ 8.00 (_____)

CERTIFICATION OF MEMBERSHIP:

I/We hereby make application for membership in the Oklahoma State Rabbit Breeders Association. And I/We hereby certify to the following: I/We am/are willing to abide by the constitution and by- laws of the Oklahoma State Rabbit Breeders Association, and I/We will do my/our part to uphold the club’s image, policies and procedures.

SIGNATURE:____________________________________________ DATE:____________________

RECOMMENDED BY:________________________________________

PLEASE PRINT & MAIL THE APPLICATION TO ADDRESS AT TOP OF FORM, WITH MEMBERSHIP DUES…….

_____________________________________________________________________________________

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SECRETARY USE ONLY:

DATE RECEIVED:____________

AMOUNT:___________________

CK#:________________________

POSTED DATE:______________

MAILED CARD:______________