Junior Meat Goat Show Circuit
2004 Membership Registration Form

1004 Virginia Circle

Big Lake, TX 76932

(325) 884-3645

$25.00 per member Date of application_______________

Name:
_______________________________________________________

Date of Birth:
_______________________________________________________

Age as of 1-1-2005:
_____ Social Security # _________________________

Email:
_______________________________________________________

Jacket Size:
(Youth) Small Medium Large (Adult) Small Medium Large

Name:
_______________________________________________________

Date of Birth:
_______________________________________________________

Age as of 1-1-2005:
_____ Social Security #__________________________

Email:
_______________________________________________________

Jacket Size:
(Youth) Small Medium Large (Adult) Small Medium Large

Name:
_______________________________________________________

Date of Birth:
_______________________________________________________

Age as of 1-1-2005:
_____ Social Security #__________________________

Email:
_______________________________________________________

Jacket Size:
(Youth) Small Medium Large (Adult) Small Medium Large

Parent's Information

Father's Name: _______________________________________________________

Mother's Name: _______________________________________________________

Mailing Address: _______________________________________________________

City: _______________________________________________________

State: _____________________

Zip: _____________________

Home Phone: ____________________________

Work Phone: ____________________________

Fax: ____________________________

Parent's Email: _______________________________________________________