Online Membership Form - New Zealand Wagyu Breeders Association

To: The Secretary,
New Zealand Wagyu Breeders Association Inc
I / We desire to be admitted as a Full / Associate Member of the Society.
If elected as a member I / We will accept membership and be bound by the Memorandum and Articles of Association and conform to the Rules and Regulations of the Association.

In support of My / Our application the following particulars are provided, as being true and correct.
Type of Membership
- Full
- Associate
Total
$ 0.00
Member*
- Individual
- Company
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Enter Email Confirm Email
Occupation
Date of Application
MM slash DD slash YYYY
Where an application for membership is from a Partnership, Company or Other Body Corporate the following section should be completed
Partnership/Company/Other Body Corporate*
Address of Applicant*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Please enter a number from 1 to 10.
Email*
Enter Email Confirm Email
Location of Cattle
Stud Name / Prefix
Date of Application
MM slash DD slash YYYY
Interest in Wagyu
Number of Wagyu Stock owned/managed:
Fullblood
Purebreed
Cross Breed
Other ( Specify )
*
- By submitting this form, you accept the terms and conditions
Credit Card*

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name