KY PFHA Membership Form

Kentucky PFHA Membership Form

To become a member Kentucky PFHA, please complete and mail in the form below.

Select Type of Annual Membership Desired

______ Individual $15.00

______ Family $25.00

______ Youth (17 yrs & below) $10.00

______ New First Time Member $00.00

List Names. For family membership, please list all family members. List farm name first if applicable and desired.

Name

Name(s)

Street/P.O.

City State/Zip

Phone

Cell Phone

Fax

Email

Website

Make check payable to: Kentucky PFHA. Mail to: KYPFHA, Candy Gibson, 71 L & N Drive, Whitesburg, Ky. 41858

Ck# Date rec'd: Amount:

Select Type of Annual Membership Desired
______	Individual	$15.00
______	Family	$25.00
______	Youth (17 yrs & below)	$10.00
______	New First Time Member	$00.00
List Names. For family membership, please list all family members. List farm name first if applicable and desired.
Name
Name(s)
Street/P.O.
City		State/Zip
Phone
Cell Phone
Fax
Email
Website
Make check payable to: Kentucky PFHA. Mail to: KYPFHA, Candy Gibson, 71 L & N Drive, Whitesburg, Ky. 41858
Ck#	Date rec'd:	Amount: