Anderson County Beekeepers Association Membership Application Form

1. 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