MANITOBA FERRET ASSOCIATION
MEMBERSHIP APPLICATION FORM

FISCAL YEAR:   Equals 6 newsletters / Membership is  prorated. 


NAME: 	_____________________________________________________

ADDRESS:	_____________________________________________________

CITY/PROVINCE:	_____________________ POSTAL CODE: ______________

HOME PHONE:  ______________ WORK: ____________PAGER: ____________ 

CELL: _______________ E-MAIL:  ____________________________________


FERRET(S)	F/M	 TYPE	   AGE	       IMMUNIZATION
NAMES:					     DISTEMPER/RABIES

__________	___	 ______	   ___	  ___________________________

__________	___	 ______	   ___	  ___________________________

__________	___	 ______	   ___	  ___________________________
	
__________	___	 ______	   ___	  ___________________________

__________	___	 ______	   ___	  ___________________________
   
__________	___	 ______	   ___	  ___________________________
 
 
The applicant agrees to abide by the By-Laws and Standards of Care set forth by the 
Manitoba Ferret Association. 
Membership is for one year (6 newsletters) from date of signing.
Membership fee is:  $30.00 for one year / 6 newsletters ____ cash  _____ cheq
I wish to make an annual Fundraising Donation of $__________ to support the association

New Member ________	Annual Membership Renewal __________

_______________________________	DATE: ___________________
Signature

Cheque Payable to: Manitoba Ferret Association 
Mail to:  11 Solace Key, Winnipeg, Manitoba, R2G 2N5