| Membership
Application/Renewal
Date:_______________________________________________
Name:______________________________________________
Farm Name:_________________________________________
NASSA Flock No:____________________________________
Street Address:______________________________________
____________________________________________________
City:_______________________________________________
State:____________________Zip:_______________________
County:_____________________________________________
Email:______________________________________________
Telephone:__________________________________________
JR Member Names:___________________________________
_____________________________________________________
No. Registered:_______________________________________
No. Unregistered Purebred:____________________________
No. Crossbreds:_______________________________________
Other Breeds:_________________________________________
Family Membership $12.00
Junior Membership $1.00 per child
Make check payable to ISSBA
Mail to:
John Salamone
10846 South 600 East
Carbon, IN 47837 |
