POLISH BREEDERS CLUB

Dedicated to Breeding, Preserving and Promoting the

Polish, Crevecoeur, Houdan and Sultan fowl to the standards set forth by the
American Poultry Association and the American Bantam Association
through education and communication.
Name: _____________________________________________ Phone Number ___________________________
Address: ___________________________________________________________________________________
City _______________________________________________________ State _________ Zip _____________
Email address ________________________________________________ Date __________________________
To keep our operating costs low we request members receive communications via email.
_____ I prefer US mail

Please add polishbreedersclubpresident@yahoo.com & polishbreedersclubsecretary@yahoo.com to your contacts.

______ Annual Individual membership $15.00 (US and Canada) ______ Lifetime Individual membership $100.00
______ Annual International membership $25.00
______ Annual Family membership $20.00

______ Annual Junior membership $5.00

Please list family members names:

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______ Lifetime Family membership $150.00 Limited to the names listed above
How are you paying for your membership?
______ Check made payable to: Polish Breeders Club
______ PayPal to polishbreedersclubmembership@yahoo.com (located on our website under the Membership tab)
By submitting this application member agrees to adhere to the Constitution and By Laws set forth by the Club. Members are eligible for club awards
based on points achieved. Points will be awarded beginning with the first show after application is approved and payment is received.

All members are included in the Membership Directory. Please provide the following information.
Which Varieties do you raise?

Large Fowl
Bantam
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Sales- _____ eggs
_____ chicks
______started birds
______ adult birds
______ Ship eggs
______Ship chicks
______Ship started or adult birds
______ Pick up ONLY
______ I do not sell
We want to introduce you to our members. Please tell us a little about you and your flock - ___________
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Return this application via email to our club secretary Tricia Olvera
polishbreedersclubsecretary@yahoo.com
Or via US mail to: PBC c/o Tricia Olvera PO Box 1, Edwards, CA 93523
If you have any questions you may also contact our club president Sherry Parker
polishbreedersclubpresident@yahoo.com
Upon approval you may begin using all the valuable reference material available at
www.polishbreedersclub.com
Forums are for members only & require approval. If you will be using a user name
different than your name or email please let us know so we know its you!
What is your desired user name? _________________________