GALA Membership Form

MEMBERSHIP FORM

Membership year runs from January 1st through December 31st
Today's Date is:

MonthDayYear
Date
My Products
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New Annual MembershipOne year membership.
$40.00



New Lifetime Membership
$500.00



Gift MembershipAny EXISTING GALA MEMBER can give one year of membership to a NEW GALA MEMBER.
$30.00



Membership Renewal
$40.00



Total

$0.00
New GALA Annual Membership
New GALA Lifetime Membership
Gift GALA Membership
GALA Membership Renewal
Membership Fee to be Charged:
Your membership will run from today until December of this year.
This membership will run from today until December of next year.
Your membership will run from today for the rest of your life.
Name of MEMBER who is giving new gift membership*
Do you wish to receive a confirmation of this gift membership?

YESNO
Your e-mail address*
Name of MEMBER who is Renewing
If your name is not on this list, enter below
If your name is not on the list, above and you are a current member (or, maybe, a past member), enter your name here.
Do you wish to receive confirmation of your MEMBERSHIP RENEWAL?

YESNO
Your current e-mail address.*
example@example.com

ENTER DATA FOR NEW MEMBER:
New Member Name*

First NameLast Name
First Additional Name

First NameLast Name
Second Additional Name

First NameLast Name
Third Additional Name

First NameLast Name
New Member Farm or Business Name (if any)
Farm or Business Email Address
example@example.com
Farm or Business Website
New Member Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
New Member Home Phone
Please enter a valid phone number.
New Member Cell Phone
Please enter a valid phone number.
New Member Second Cell Phone
Please enter a valid phone number.
New Member Work Phone
Please enter a valid phone number.
New Member Email Address*
This is a required field. It's really the best way to keep in touch.
Do you want the New Member to receive notice of your gift via email?

YESNO
New Member Additional Email Address
example@example.com
Were you referred to GALA by an existing Member? If so, could you let us know who?
Do you wish to update your mailing address?

YESNO
New Mailing Address
Please consult your GALA Directory Entry or your renewal notice and let us know of changes that you would like to make to your membership records (e.g. new telephone number, changes in camelid counts, etc.). Contact Miranda Brown if you have questions: thellamalady@yahoo.com
Would you like to supply animal counts and vet info?

YESNO
Please enter the number of llamas and alpacas that are part of your farm in the fields below.
Intact Male Llamas
Female Llamas
Gelding Llamas
Intact Male Alpacas
Female Alpacas
Gelding Alpacas
Veterinarian information is not required. However, if you would like to share it with the GALA community, enter data here.
What is the name of your veterinarian?
Include Name of Veterinary Practice
What is the address of your veterinarian?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Veterinarian Phone Number and/or Email Address
Anything else you would like to tell us about your GALA Membership?
Your personal information will not be shared on the GALA website but it will be included in the GALA Membership Directory.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

MEMBERSHIP FORM

New GALA Annual Membership

New GALA Lifetime Membership

Gift GALA Membership

GALA Membership Renewal

Your membership will run from today until December of this year.

This membership will run from today until December of next year.

Your membership will run from today for the rest of your life.

ENTER DATA FOR NEW MEMBER:

Please enter the number of llamas and alpacas that are part of your farm in the fields below.

Veterinarian information is not required. However, if you would like to share it with the GALA community, enter data here.

Your personal information will not be shared on the GALA website but it will be included in the GALA Membership Directory.