LAST NAME: _______________________________________________

FIRST NAME(S) ________________ ___________________

________________ ___________________

HERD NAME: ________________________________________________

MAILING ADDRESS: __________________________________________

CITY, STATE, & ZIP: __________________________________________

TELEPHONE: _________________________________________________

E-MAIL: _____________________________________________________

INTERNET HOME PAGE ADDRESS: ____________________________

Circle Membership Category: FAMILY-$20.00 (2 Votes)

SINGLE-$10.00 (1 Vote)

ASSOCIATE-$7.00 (Non-Voting)

DUES ARE PAYABLE ON JANUARY 1^ST OF EACH YEAR.

Send application and check to: Kids at Heart Pygmy Goat Club