____ New ____ Renewal
Date:_____________
___ Youth $6.00
___ Single membership $ 8.00
___ Couple $12.00
___ Family membership $15.00
Name(s):_________________________________________________________
_________________________________________________________
Street:__________________________________________________________
Town:____________________________ State:______ Zip code:_________
Phone#:________________________ Email:___________________________
ARBA member: ___ NO ____YES
If yes, ARBA #_______________________
Signature:_______________________________________________________
Make checks payable to : Eastern Holland Lop Specialty Club
Email me at: jaylene@jaylene.com and I will send you the mailing address of our treasurer, to mail your check. You can copy and paste this application in an email, fill in the blanks and email it to me, as well.