ANDDA MEMBERSHIP APPLICATION

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

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

*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.

*Individual is voting member

TOTAL MEMBERSHIP FEES: ${totalMembership110}
MEMBERSHIP TYPE: *

Individual Membership* Individual* & Affiliate Membership Individual* & Family Membership Individual* & Youth Membership Youth Only Membership
Number of Youth
Early Bird Coupon
Total Membership Fees
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
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
Fee
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
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 DO NOT list Youth Names

2023 ANDDA GESTATIONAL CALENDAR

Members will receive a free annual ANDDA gestational calendar when joining/renewing before December 31, 2022. Additional calendars are available for purchase for $10 each and small shipping fee of $3.00. Calendars will be mailed by beginning December 15, 2022.
Yes, I'd like to order additional calendars for just $10 each + shipping No thank you, but can't wait to get my 2023 calendar!
Qty *
calendar total
Shipping / Handling
Total Calendar Order
Calendars + $3.00 s/h
Calendar Mailing Address if Different that above address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Payment Option *

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

Payment & Submission

Debit, Credit Card option

SUMMARY:

		Individual	${individual}.00
		Affiliate	${affiliate}.00
		Youth	${youth}.00
		Early Bird	${earlyBird}.00
		Calendars	${totalCalendar}.00
			${totalMembership110}.00

INDIVIDUAL
YOUTH
AFFILIATE
Calendars

Payment & Submission

SUMMARY:

		Individual	$${individual}.00
		Affiliate	${affiliate}.00
		Youth	${youth}.00
		Early Bird Discount	${earlyBird}.00
		Total Calendars	${totalCalendar}.00
		GRAND TOTAL	${totalMembership110}.00

Print to mail application and check/money order to:

ANDDA
c/o Carol Harlan Van Wert
29555 SW Mill Creek Rd
Sheridan, OR 97378

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