NORTH CAROLINA RABBIT BREEDERS ASSOCIATION
Membership Application
Affiliated with The American Rabbit Breeders Association
Return to NCRBA Secretary:
Bill Whaley
131 Maple Ridge Dr
Old Fort, North Carolina 28762
Enclosed is $___________________ with my completed application for membership in the North Carolina Rabbit
Breeders Association (NCRBA). I agree to abide by the Constitution & By-Laws of the Club and to further the interest
of the Association when ever possible.
Secretary Use
Only:
(Please print clearly and list birthdays next to all names. Youth members must include year)
Date of Application_______________________ Phone #’s_____________________________________
NCRBA #
Name of Applicant_______________________________________________
Spouse’s Name_________________________________________________
Additional Adult_________________________________________________
Youth Name_____________________________D.O.B._________________
Youth Name_____________________________D.O.B._________________
Youth Name_____________________________D.O.B._________________
Youth Name_____________________________D.O.B._________________
Address:_____________________________________________________________________________
Street / Appt #
_____________________________________________________________________________________________
City
State
Zip
County
Email Address (Primary)
__________________________________________________________________
Breeds Raised:____________________________________________________________________________
Would it be acceptable to send an electronic copy of the “NEWS” (PDF copy) to save on postage? YES___ NO____
A $5.00 surcharge per year will charged to mailed newsletters excluding life members.
Please circle Applicable Membership to right & below:
NEW__________ RENEWAL______________
Single Membership $10.00 Husband Wife $12.00 (2 adults same address) Family (Household) $17.00 Single
Youth Membership $5.00, Lifetime single $125, Lifetime Husband & Wife $175
Secretary Use Only:
MlO#_______________________ Date Received_____________________________________________
Amount received $_____________________check #_________________
Date Membership Cards, newsletter sent:_______________________________
Exp Date__________________________________________________