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PRINT AND MAIL APPLICATION WITH CHECK OR MONEY ORDER

MADE PAYABLE TO ETGRA. 

 

ETGRA         c/o Ann Rodgers                                 3161 CR 1707 Jacksonville, TX 75766

DATE _____________

 

NAME _________________________    

 

FARM NAME__________________________                                               

                                  

ADDRESS _______________________________

 

CITY AND STATE _________________________

 

ZIP  ___________COUNTY OR PARISH ___________________

 

TELEPHONE NO. ______________   EMAIL ADDRESS ___________________________

 

PLEASE CHECK THE APPROPRIATE ANSWERS BELOW:

 

MEMBERSHIP TYPE- REGULAR ____JUNIOR ______

 

Do you wish to be listed on the website? ___Yes  ___No

 

With your telephone number   ___Yes  ___No

With your email address          ___Yes  ___No

 

Website address to link to etgra website  www._________________________

 

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 Regular membership  - $35.00    

 Junior membership- $10.00 (up to age 19)