KENTUCKY NUT GROWERS ASSOCIATION David Leeper, Treasurer 2209 Middleground Dr. Owensboro, KY 42031

FIRST CLASS

MEMBERSHIP APPLICATION KENTUCKY NUT GROWERS ASSOCIATION

TO: David Leeper DATE _____ 2209 Middleground Dr. Owensboro, KY 42031

□ NEW MEMBER RENEWAL

CHANGE OF ADDRESS

NAME ___

ST OR RFD ___

CITY ___ STATE ___ ZIP ___

OCCUPATION _____ COUNTY _____

AMT. ENCLOSED FOR DUES $_____ FOR YEAR(S) _____

Dues are 5.00 for one year. Annual membership begins January 1st. New members joining after July 1st shall be credited as paid in full for the next calendar year.)