If you would like to join JBOA by mail, please print this application, fill out and mail to address below with the appropriate dues payment.JAVA BREEDERS OF AMERICA - YEARLY MEMBERSHIP DUES:

Juniors (17 years and under): $5.00;Individuals: $10.00;

Families: $15.00;Foreign Members (anyone living outside the USA): $20.00 (US funds!)

Benefits: Quarterly Club Newsletters, Annual Breeders Directory, and access to the website's member area which includes: access to classifieds, member forum, member directory, immediate access to quarterly news-

letters, and email updatesDate:__________________________

Name:____________________________________________________

Address:___________________________City:___________________

State:_________________ Zip code______________-_________ COUNTRY________________________

Phone:(___ ) ___________ E-Mail Address:___________________Web Site URL: ____________________

Membership Type (Circle one): JUNIOR______INDIVIDUAL _______FAMILY _______FOREIGN______

Check One: NEW MEMBER_____________ RENEWAL_________________

For website access of ‘Member’s Area’: Desired USERNAME:_____________ PASSWORD: ______________

Receive Quarterly newsletter by: MAIL ________________E-Mail__________________

Note: Please only request mail version of newsletter if you do not have an email address.Types of Javas that you raise:

Mottled:___(YES)___(NO) Black:___(YES)___(NO) White:___(YES)___(NO)Auburn:____(YES)____(NO)

Do you offer your Javas for sale? What colors?___________________________________________________

Do you sell chicks?_____________Do you sell eggs?_______________Do you sell adult birds?___________

Other Breeds and varieties of fowl that you raise:________________________________________________

_______________________________________________________________________________________

How long have you raised Javas? ____________________________________________________________

Do you show Javas?____________________________________________________________________

What is your main reason for keeping Javas? (Attractive egg layers, Preserve the breed, backyard pets.....)

_______________________________________________________________________________________

Mail the completed form with appropriate dues payment to:Java Breeders of America

Ruth Caron - Secretary/Treasurer195 Northglen Lane

Martindale, Texas, 78655, United States

Java

Breeders

of Americaof America1883