Arizona State Dairy Goat Association

              Application for Membership

 

 

Membership Dues:  Single $15.00 _____  Family $20.00 _____

 

Name ___________________________________________________________

 

Herd Name  ______________________________________________________

 

Address _________________________________________________________

 

City _________________________ ST _____  ZIP  ______________________

 

Phone _______________________  Cell  ______________________________

 

email ___________________________________________________________

 

 

  Family Member's Birthdates (MM/DD/YY):                 Breed of Goat(s):

 

Self/Date_________________________      ____________________________

 

Spouse Name/Date________________       ____________________________

 

  Child Name/Date_________________       ____________________________

 

  Child Name/Date_________________       ____________________________

 

  Child Name/Date ________________

 

  Child Name/Date ________________

 

 

  I hereby give ASDGA permission to use pictures of myself and family members

from shows, meetings, and/or other ASDGA functions in any ASDGA publication.

                                                       ____ initials

 

  I hereby give ASDGA permission to publish my name, address, phone, email

information on ASDGA’s website.  I understand ASDGA will not sell my infor-

mation to any entity.                      ____ initials

 

Send Applications to:         Denise Thomas

                                           13805 E. Appleby Rd.

                                           Chandler, AZ  85249

 

Please make checks payable to:  ASDGA