Annual Membership IF postmarked by MARCH 1, 2010 .....$175.00
$50.00 LATE FEE IF postmarked AFTER March 1, 2010 .......$225.00
NAME and ADDRESS of ORGANIZATION:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
PHONE:________________________
FAX:___________________________
E-MAIL:_________________________________________________________
WEB SITE:______________________________________________________
PRIMARY OFFICER:_____________________________________________
TITLE:_______________________________________________________
PRIMARY OFFICER’S E-MAIL__________________________________
PRESIDENT’S NAME__________________________________________
ADDRESS____________________________________________________
DATA: (FROM YOUR MOST RECENT YEAR)
REGISTRATIONS ____________________
TRANSFERS ____________________
ACTIVE MEMBERS ____________________
LEADING STATES IN REGISTRATIONS
1. ___________________________
2. ___________________________
3. ___________________________
4. ___________________________
5. ___________________________
NAMES AND ADDRESSES OF OFFICIAL BREED PUBLICATIONS:
____________________________________________________________________________________________________
CIRCULATION__________
____________________________________________________________________________________________________
CIRCULATION__________
____________________________________________________________________________________________________
CIRCULATION__________
RETURN BY TO:
ZANE AKINS, TREASURER
177 PALERMO PLACE
THE VILLAGES, FL 32159-0094
TEL: 352-259-6005 FAX: 352-259-6005 (NOTE: IF YOU FAX YOU MUST CALL FIRST)
Email: zaneakins@gmail.com