A $10.00 check made payable to Heart of America Game Breeders' Association must be sent with this application to Mrs. Terry Smith, 14000 West 215th ST., Bucyrus, KS 66013-9519. If there is not enough space provided below for listing the species you raise, feel free to write them on a sheet of paper which you may attach to the application.
Name: ________________________________________________
Farm Name: ___________________________________________
Address: ______________________________________________
City:____________________________________ State:________
Zip Code: ________________ Country:_____________________
Phone: (_____ ) _________________
E-Mail Address: _______________________________________
Pheasants:
Peafowl:
Quail, Partridge, Grouse & Francolin:
Wild Waterfowl:
Misc.:
If accepted for membership, I would be willing to help with these club activities:
_____ Promote membership in my area.
_____ Write Helpful Hints for the newsletter.
_____ Write an article for the newsletter.
_____ Help with auction or swap.
Signature:____________________________________ Date:______________
http://www.gbwf.org/hoagba/application.html