PLEASE PRINT CLEARLY
New Member _______ Renewal _______
Paid By: Cash____ Check # _______ Amount: $________________
DATE: _______________
Your Name: _____________________________________________________
Spouse/Partner's Name: ___________________________________________
Name of Farm/Aviary: _____________________________________________
Street Address: __________________________________________________
City:___________________________________________ State:____________ Zip __________________ - _________ 9 DIGIT PLEASE
Telephone (H): __________________________________________________
Fax: __________________________________________________________
Email: _________________________________________________________
Website: ______________________________________________________
How Long Have You Raised Birds? __________________________________
Who Referred You To CVPWS? ____________________________________
Enclose $20.00 for New and Renewal Membership (Jan. 1 through Dec 31)
Non-renewals, as of the 31st of Jan) will be unable to be listed in the Annual Membership Directory.
Late Renewals past the Annual Directory mail-out (April 12th) will need to pay postage for back issues.
For CVPWS Patch, please enclose $5.00 per patch plus $1.00 postage.
Make payable to: (CVPWS)
Mail to : E. T. Trader, CVPWS Treasurer
6220 Bullbeggar Road
Withams, VA 23488-2700