GALA Membership Form

MEMBERSHIP RENEWAL/UPDATE/ DONATION

Membership runs from January 1st through December 31st
Choose below. If you are just making a donation or just updating your membership information, click off the renewal checkmark.
Renewal and Donation Options*
prevnext( X )
Membership Renewal
$40.00



Donation to GALA
$10.00 Quantity



Donation to GALA
$25.00 Quantity



Donation to GALA
$50.00 Quantity



Total

$0.00
Today's Date is:

MonthDayYear
Date
Your membership will run from today until December of this year.
Your membership will run from today until December of next year.
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
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.
Name of MEMBER who is renewing
Can't find your name? 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.
Your Name*

New Member Email Address
example@example.com
New Member Additional Email Address
example@example.com
Do you want the New Member receive notice of your gift via email?

YESNO
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. email addresses, websites, 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?
What is the address of your veterinarian?
Veterinarian Phone Number and/or Email Address
Anything else you would like to tell us about your GALA Membership?

Payment Methods

Debit or Credit Card

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

Choose below. If you are just making a donation or just updating your membership information, click off the renewal checkmark.