KENTUCKY TAXIDERMIST ASSOCIATION INC. www.kytaxidermy.com Membership Application Name _________________________________ Shop Name _________________________________ Address _________________________________ Telephone _________________________________ Cell # _________________________________ Home # _________________________________ Email address _________________________________ Web site Address ________________________________ Is this your first membership with the K.T.A.? YES NO If no.... What year was your last membership?__________________ Please tell us about yourself. Full Time_______Part Time________Hobbyist____________ How Long in Taxidermy________Married_________ Children ?_________________ If Part Time what is your regular Job______________________________________ Spouse's Name__________________Spouse Occupation____________________ How did you hear about the KTA?________________ Would you be interested in becoming a board member in the future? ___________ Do you belong to the NTA?___DU____NRA____NWTF____QDMA___LKS_____WU_____ QU_____RMEF_____ SCI _____Sportsman's Alliance_______ Boone and Crockett Club _____ Pheasants Forever ______Bass Masters_________Other __________ KTA dues are $60 annually Make checks payable to KY Taxidermist Association and mail to KTA Brian Bliese 5010 Prosperity Lane Hopkinsville, KY 42240 |
| Hold mouse pointer over application ..right click...then click on Print. Send Application with $60 dues to address below |
| MEMBERSHIP APPLICATION: |
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| For more information contact membership@kytaxidermy.com |
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