AMERICAN FUZZY LOP RABBIT CLUB

APPLICATION for MEMBERSHIP:

NAME________________________________________________________________

ADDRESS_____________________________________________________________

CITY___________________STATE_____ZIP_________PHONE_________________

Email Address___________________________

Birth Date (youth only)______________

Signature _____________________________

Referred By: ____________________________

Check all which apply:
US Membership (Single - open or youth)
NEW: $17/yr _______ $37/3yr _______

RENEW: $12/yr _______ $32/3yr ______

(Family--2 members/same address)
NEW: $22/yr _______ $54/3yr _______RENEW: $17/yr _______ $48/3yr _______

** Add $2 each PER YEAR for over 2 persons **
Canadian: $22 US/yr single______ All other foreign (single): $35 US/yr_______

TOTAL AMOUNT ENCLOSED:_____________
Checks should be made payable to: American Fuzzy Lop Rabbit Club
Mail to: Muriel Keyes, 14255 SE Stephens, Portland, OR 97233

Back to the American Fuzzy Lop Rabbit Club

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Rob & Paula Grady at:
AFLRCwebmaster@ATT.Net