GULF COAST COWDOG

ASSOCIATION   2004

 Membership Application

 

 (Please Print)                       Paid By: CASH________ or CHECK_________

 

Name:__________________________________  Family Membership _____

 

Address: ________________________________ Single Membership ______

 

City: ___________________________________                    Renewal ______

 

State/Zip:________________________________           New Member:_____

 

Phone (home):________________________ (work)_____________________

 

E-mail Address:_________________________________________________

 

Family membership…$30.00 per year

Single membership….$20.00 per year

 

Please include annual membership dues with signed application and mail to:

 

Gulf Coast Stockdog Association

C/O Keith Gilleon

4193 Richmond dr.

Ethel, LA 70730

 

I (print name) _______________________________, will not hold the Gulf Coast Stockdog Association, any officer, board member, member, worker, landowner or

Livestock owner liable for any accident, injury, death or damage to myself or any of my property. I enter this agreement at my own risk.

 

               (signature) ______________________________   (date) ___________

 

 

Bart Hobbs 

  E-mail  hobbsjb@ev1.net