Membership Application

Virginia Holstein Association
PO Box 340
Midland, Virginia 22728

Date___________        

Name_____________________________ County ______________________
     ( Must be exactly the same as you register your animal )

Address________________________________________________________

Post Office _______________________ State _______ Zip Code __________

Telephone # _________________________ Fax #   _____________________

HFA Account # ______________________ DHIA Code #  _______________

E-Mail Address  _________________________________________________

Number of cows recorded by Holstein USA ______________

Membership Fee, Base Charge................................................                $29.00

PLUS Fee of $1.10 per cow* (155 Head Max)   _____X $1.10 = $_________

Total Membership Fee  Check enclosed for.................................    $_________
  * Cow recorded by HOLSTEIN USA milking or dry