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		REGIONAL FLEMISH GIANTS RBA APPLICATION FOR MEMBERSHIP
	1 Year Membership ___Single or Youth $7.00   ____ Husband/ Wife(2 person House)$10.00 _____ Family $10 (+$2.00 ea youth) 3 Year Membership ___Single or Youth; $18.00 ____ Husband/ Wife(2 person House) $10.00 _____ Family $25 (+$5.00 ea youth)
		Name _____________________________________________  Phone#:_____________ Address:___________________________________________________________________ City:___________________________________State:_________________Zip:___________ Email address:______________________________________________________________ Colors Raised:______________________________________________________________ Referred By:_______________________________________________________________
							Mail Application  and  Check to : Will Sutton RFGRBA - President 9055 SW Hwy 82 El Dorado Springs, MO
			Date of Application ________________