Membership runs from July1st to June 30^th

Annual Membership $35.00 o Lifetime Membership $500.00 o

Please mail this form with your check to: GALA Membership

c/o Mail Boxes Etc.

6059-952 Allentown Boulevard, Harrisburg, PA 17112-2670

Check here if: ____Information Update only

____New Lifetime Member

____New Annual Member

___ Renewal

____Donation $______

Primary Name_______________________________________________

Additional Name_____________________________________________

Farm Name_________________________________________________

Address___________________________________________________

City _______________________________ State__________________

Zip ___ ___ ___ ___ ___ + ___ ___ ___ ___ ___

Home Phone Number____________________________________

Fax Phone Number______________________________________

Work Phone Number_____________________________________

EMAIL Address_________________________________________

Website_______________________________________________

Intact Males ______ ______

Females ______ ______

Geldings ______ ______

My Veterinarian’s Name__________________________________

Address and Phone number______________________________________