2008 kphBA membership form

Name:___________________________________________________________________

Farm Name:_______________________________________________________________

Address:__________________________________________________________________

________________________________________________________________________

City:__________________________________________  State:________ Zip:___________

Phone:___________________________________  Fax:____________________________

e-Mail Address:_____________________________________________________________

Web Site Address:____________________________________________________________

Youth Name(s) & Birthdate(s):___________________________________________________

  New Membership   Renewed Membership         Address Change

Membership Type:                    Individual                         $15.00

                                                  Family                            $25.00

                                                  Youth  (18 & Under)       $10.00

Please make check payable to KPHBA, and send to Kathryn Graves, 3310 Cynthiana Rd., Georgetown, KY 40324.  Membership Expires December 31, 2005.