Cluck and Quack Poultry Club
20__ MEMBERSHIP

Send renewal with $15.00/family/year to : Tricia Anderson
                                                                           Box 7, Grp 406, RR 4
                                                                                 Beausejour, MB R0E 0C0

* Make cheque payable to 'Cluck and Quack Poultry Club'
By becoming a member,
I agree not to use the Membership Directory for any reason
other than personal contact with other members of the Club.

NAME:___________________________________ current member #__________

ADDRESS:________________________________________________________

                  ________________________________________________________

POSTAL CODE:__________________PHONE NUMBER: __________________

EMAIL ADDRESS:__________________________________________________


POULTRY AND OTHER CRITTERS OWNED:

BANTAMS:________________________________________________________
STANDARDS:______________________________________________________
      Pheasants_______________________________________________________
__________________________________________________________________
      Ducks__________________________________________________________
__________________________________________________________________
     Geese__________________________________________________________
__________________________________________________________________
      Other _feathered-_________________________________________________
        _non-feathered-_________________________________________________
     At home Business_________________________________________________
__________________________________________________________________