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EASTERN BISON ASSOCIATION

Membership Application

Please print and fill out the membership form below and mail or fax it with your payment.

Name of Applicant(s):_______________________________________________
Farm or Ranch Name: _______________________________________________
Mailing Address: _______________________________________________
City: _______________________________________________
State: _______________________________________________
Zip Code: _______________________________________________
Telephone#: (H) _______________________________________________
(W) _______________________________________________
Fax#: _______________________________________________
Email Address: _______________________________________________

CHECK ONE
( )Active (owns at least (1) live Bison) Membership $50.00
( )Associate Membership $50.00

Referring Member: ________________________________________________

What can the Eastern Bison Association offer you: _________________________________________________________________________________

What qualities can you offer the Eastern Bison Association: ___________________________________________________________________________________

I have read and agreed to obide by the Eastern Bison Association Code of Ethics as a requirement for membership and that the above information is correct.

________________________________
Signature

________________________________
Date

Please mail completed applications with membership dues to:

Wray Dawson, Membership Chairperson, 26690 Gum Spring Rd. Chantilly, Va. 20152

EASTERN BISON ASSOCIATION

Email: LBrooker@aol.com