Membership Application

Name____________________________________________ Date __________________

Address _____________________________________________________________________

Phone Numbers ______________________________________________________________

Fax # ____________________________ OK Hrs to call ___________________________

e-mail _______________________________________________________________________

Membership Type:

Family/ Institution $20 _________ Single $10 _________ Student/Child $5 __________

Interest:

What types of cold-blooded animals are you interested in or own?

Past: ________________________________________________________________________

Present: ______________________________________________________________________

Future: _______________________________________________________________________

How can this association be of service to you?

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Membership information is never sold or released to the public.

Can your information be released to the general membership?
_____________________________________________

Have you reviewed and accept the guidelines and code of ethics that govern this Association ?
__________________

Mail Applications To:

T.S.A.R.A.

P.O. Box 47

Dry Ridge, KY 41035

Signature of member : _______________________________