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NDGA 2009
MEMBERSHIP APPLICATION
NAME
MAILING ADDRESS
CITY
STATE
ZIP (include 4 digit extension)
TELEPHONE #
OTHER CONTACT # (cell phone)
EMAIL ADDRESS
WEBSITE ADDRESS (if applicable)
TYPE OF MEMBERSHIP
FAMILY ($35)
INDIVIDUAL ($25)
LIFETIME ($300)
CANADIAN & OVERSEAS (please add $5 additional for membership)
AUTHORIZATION FOR PUBLICATION
YES, I/WE authorize information to be published on NDGA's website, members roster and Dwarf Digest.
NO, I/WE do not authorize information to be published.
INTERESTED IN HELPING ON A NDGA COMMITTEE
YES
NO
NOT AT THIS TIME
COMMITTEES OF INTEREST:
MILK PROGRAM
SHOWS
PUBLICITY
DWARF DIGEST
JUDGES TRAINING
YOUTH PROGRAM
REFERRAL? (please include source)
REASON FOR BREEDING/OWNING NIGERIANS
MILK
PETS
HOBBY
SHOW
BUSINESS
ALL OF THE ABOVE
OTHER (use note section)
NOTE:
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