POLISH BREEDERS' CLUB
                        
                          ***** MEMBERSHIP FORM*****

Member Dues are $10.00 for an individual and $15.00 for a family per year. Life time membership is $100

Send a copy of this application and a check/money
order  payable to "Polish Breeders' Club" to or pay-pal at polishman@watchtv.net add $1 to cover their fee's. Please send below info as well.

Jim Parker
3232 Schooler Road
Cridersville, Ohio 45806

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TELEPHONE NUMBER (optional)_______________________

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E-mailed newsletters or snail mail ___________________________

Life or yearly Membership ________________________________

Do you sell eggs/chicks/adults (for directory) _____________________

Do you ship or are they pick up only ( for directory) _______________

Please list the breeds of Polish you raise ________________________

LARGE FOWL                          BANTAM                                            

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