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Anderson County Beekeepers Association Membership Application Form - PowerPoint PPT Presentation


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Anderson County Beekeepers Association Membership Application Form Membership year runs from January 1 st through December 31 st. Dues are: Individual - $8.00 Family - $10.00 (make checks payable to ACBA). Name: __________________________________________________________________

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Anderson County Beekeepers Association

Membership Application Form

Membership year runs from January 1st through December 31st.

Dues are: Individual - $8.00 Family - $10.00 (make checks payable to ACBA)

Name: __________________________________________________________________

Work Phone Number: __________________

Address: ________________________________________________________________

City : _______________________________ State: _________ Zip: ________________

County of Residence: ____________________________ Number of Colonies: ________

Years as Beekeeper: _____________ e-mail address: ____________________________

Membership Type: (Please check one) Individual ________ Family _________

Would you like to receive your newsletter via e-mail? Yes _________ No ____________

Our organization’s purpose is for the education, support and encouragement of beekeeping. In the interest of communication among members, do you have any objection to the above information being published in the ACBA directory? Yes __________ No __________

If so what information do you want omitted? ______________________________________

If you want to join/rejoin TBA at this time, please fill out the form below with information not shown on your ACBA form.

2009 Tennessee Beekeepers Association Membership Application 2009

Please check one: __________ New Member __________ Renewal

Name: ___________________________________________________________________

Street: ___________________________________________________________________

City : ____________________________ State ___________ Zip _____________________

County: _________________________________ Phone Number: ____________________

Local Association: __________________________________________________________

Local Association Position: (Pres. V.P., etc) ______________________________________

Check one if applicable: _____ TBA Director _____ TBA Alternate Director

TN Apiaries Registration Number (if known): ______________________________________

Number of Colonies: _____Years as a beekeeper: _____ Year joined state association: ________

Want your newsletter via e-mail? E-mail address: ______________________________________

Please select type of membership desired:

1 Year Membership Single: $10.00 _____ Family (Up to 4 family members*): $22.00 ______

2 Year Membership Single: $18.00 _____ Family (Up to 4 family members*): $40.00 ______

3 Year Membership Single $26.00 _____ Family (Up to 4 family members*): $80.00 ______

Gold Membership (lifetime): $175.00 _____

*enter names of additional family members __________________________________________

Please mail form and dues to: Petra Mitchell, Treasurer 3900 Rock Springs Rd. Watertown, TN 37184