Chinchillas As Pets Association

I, __________________________________ , am an owner/breeder of one or more chinchillas, and would like to apply for a membership with CAPA and agree to the following conditions:

1. I agree to pay in advance the sum of $20.00 to be used as an annual membership fee.
2. I have read and agree to the Mission Statment & By-Laws set forth by CAPA and will do my best to uphold any and all rules and regulations set within the association.
3. I am not now, nor will be in the future a pelter, breeder for pelters, pet broker, or pet store breeder. All chinchillas sold or given by me are for individual pet homes or pet breeders only.
4. I reserve the right to cancel my membership at any time with written notice to the Board of Directors.
5. I agree to relinquish my membership with a majority rule vote by the Board of Directors.
6. I agree to respect all other members and make any complaints or inquiries through either the person(s) involved or the Board of Directors only.

PLEASE FILL IN ALL APPLICABLE INFORMATION: (incomplete applications may be refused. All members under 16 must submit parental consent form)

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Applicant: _______________________________ Ranch Name: ___________________
(Print Name)

Applicant�s Address: ___________________________________
(Please print street number, name and apt #)

City:_______________________ State:___________ Zip Code: ______________

Email Address: ________________________________________

Phone Number:__________________ Fax Number: _____________________

Date of Birth: ________

Children names eligible for Junior Class:

Name: __________________ DOB: ______

Name: __________________ DOB: ______

Name: __________________ DOB: ______

X __________________________________ Date Signed: _______________
(Applicant Signature)