FARM/HERD NAME ____________________________________________

NAME________________________________________________________________

RR or STREET________________________________________________________

CITY________________________________________________________________

STATE_______________________________________________________________

ZIP CODE____________________________________________________________

PHONE NUMBER________________________________________________________

EMAIL_______________________________________________________________

WEB SITE____________________________________________________________

O Enclosed is my check ($25.00) for a membership in MO Dexter Breeders Association.

O Enclosed is my check ($15.00) for renewal of my MDBA membership.