Application for Membership in the Mini Lop Rabbit Club of America

Send To:
PENNIE GROTHEER, SEC./TREA.
P.O. BOX 17
PITTSBURG, KANSAS 66762
(417) 842-3317

(To Receive 1st Class Postage or Foreign Countries Add $5.00 per year)
Please allow 30 days for processing. Please pay in U.S. Funds

YOUTH $10.00 or 2 years for $15.00
SINGLE $15.00 or 2 years for $28.00
HUSBAND/WIFE $18.00 or 2 years for $34.00
FAMILY $20.00 or 2 years for $38.00

Date of Application:____________

Name(s):______________________________________________________

Address:______________________________________________________

City: _____________________________                  State:____ Zip:________

Phone: (____)_____________    E-mail address: _______________________

Youth Names (Under 18 years):_____________________________________

Date(s) of Birth:____________________

ARBA number: _____________(if app)

Recommended by: ___________________

I hereby make application for membership in the Mini Lop Club of America with the intention to promote the breed. I agree to abide by the Constitution and By-Laws.
Signed:_______________________________________________________