VBSANA Membership Application

Valais Blacknose Sheep Association of North America

APPLICATION FOR MEMBERSHIP & RENEWAL FORM
• If you wish to Renew your membship you can renew online vbsana.com > member area
• If you are a NON-MEMBER breeder, join VBSANA as an ACTIVE MEMBER
• If you are an ACTIVE MEMBER RENEWING, Thank you!!
Membership Type
Membership Number
Name

First NameLast Name
Farm Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Website
Daytime Phone
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.Format: (000) 000-0000.
Junior Member Date of Birth

MonthDayYear
Date
Membership
prevnext( X )
Active Member
$35.00 Quantity



Lifetime Member
$250.00 Quantity



Junior Member
Under the age of 18

$10.00 Quantity



Sheep Search
$100.00 Quantity



Total

$0.00
Payment by check or credit card?
- All credit card transactions will be charged a 15 cent transaction fee and a 3.5% convenience fee on the total amount.
- ALL WORK requested MUST HAVE accompanying PAYMENT TO PROCESS
Card Number
Name on Card
Expiration Date
Three Digit Code (CVV)
Zip Code of Billing Address
Signature of Card Holder
Should be Empty:

Valais Blacknose Sheep Association of North America