Heart of America Game Breeders' Association

Membership Application

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: _______________________________________

Species List for Directory



Quail, Partridge, Grouse & Francolin:

Wild Waterfowl:


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:______________