ANDDA MEMBERSHIP APPLICATION

HOW YOU ENTER YOUR INFORMATION IS HOW IT WILL DISPLY ON THE WEBSITE MEMBERSHIP LIST

Membership runs on a calendar year of January 1 - December 31

	New/Renewal*	$15.00
	Affiliated Membership**	$5.00
	Youth Membership***	$5.00

*New members joining between September 1 and December 31 will be considered paid through the following calendar year.
**Affiliated members must include an Individual Membership to qualify.
***Is one individual Youth, and the discounted $5 for each additional family member does not apply.

TOTAL MEMBERSHIP FEES: ${totalMembership110}

Membership Type *

New Renewal Youth
Total Membership Fees
Fee
Individual Member Name
Last Name, First Name
Fee
Affiliate Member Name
Spouse, Partner, Additional Household Member
Fee
Youth Name
Last Name, First Name
Date of Birth
Fee
Youth Name
Last Name, First Name
Date of Birth
Fee
Youth Name
Last Name, First Name
Date of Birth
Herd Name *
N/A if no herd name
Website address *
N/A if no website
Email *
example@example.com
Phone Number *
Address *
Street Address
City *
State *
Zip Code *
0000 if 4 digit unknown
DHIA Member

Yes, my herd is on DHIA
Farm Logo for Website

Browse Files

Cancel of
MEMBERSHIP DIRECTORY

ANDDA publishes Member's name, and any associated names, herd name, phone number, email address, website address, city, and state to the Members Directory. Member's names will be listed alphabetically by last name and state.
Member Directory:

Post to the Membership List DO NOT list in the Membership Directory
Payment Option *

PayPal (preferred method) Check/Money Order (print form and mail)

TOTAL MEMBERSHIP FEES

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USD
INDIVIDUAL
YOUTH
AFFILIATE

Payment & Submission

SUMMARY:

		Individual	${individual}.00
		Affiliate	${affiliate}.00
		Youth	${youth}.00
			${totalMembership110}.00

Print to mail application and check/money order to:

ANDDA
c/o Aleshia Girod
774 Finch Ct NE
Salem, OR 97317

Should be Empty: