Date

First Name

Last Name

Rabbitry Name (if any)

Address

City

State

Zip Code

Home Phone Number (including area code)

Email Address

Website Address (if any)

Angora Breeds Raised: (circle all which apply)

English

French

Giant

Satin

Other (please list)

Recommended for OSARBA membership by anyone? If so, who?

ARBA Member?

Yes or No

NARBC Member?

Yes or No