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APPC Membership Application

American Pigmy Pouter Club
MEMBERSHIP APPLICATION

Regular Membership(U.S.&Canadian)-$15.00*
Family Membership(U.S.&Canadian)-$15.00*
International Membership-$20.0
(* All Funds are in U.S. Currency)

Please Make Checks Payable to "American Pigmy Pouter Club"
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Name_______________________________________
Junior______ Senior________
Address_____________________________________
City_________________ State___________ Zip________
Phone________________ E-Mail___________________
Breeds/Colors Raised:____________________________
________________________________________________
________________________________________________
________________________________________________
Other Club Affiliations:________________________
________________________________________________
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*Print and cut this page at the line above*

*Send application to:

Stanley Staveckis
PO Box97
Clayton,NY 13624
spsbird@twcny.rr.com
(315)686-2694