Virginia Poultry Federation Membership Application

YES, I WANT TO JOIN THE UNIFIED VOICE OF VIRGINIA'S POULTRY INDUSTRY. SIGN ME UP TODAY!
Please check the boxes next to the membership options you desire:

Grower joining for $30 (1/2 off for the 1st year) and $60 in succeeding years
     - Broiler, Breeder, or Pullet Grower
     - Turkey Grower
     - Invoice me annually
     - Deduct my dues from flock settlement
        (Automatically continues year-to-year unless and until membership cancelled in writing)
- Associate Firm joining for $250/year
- Associate Individual joining for $50/year
- Friend of the Federation for $50/year
- Rockingham Poultry Servicemen's Committee for $50/year
- Half priced subscription to Farm Chronicle for $15/year

First and Last Name:


Farm/Company Name:


Address:


Phone:


Fax:


E-mail address:


Contracting with:

(if applicable)

Referred by:

(if applicable)