2012 PLTA APPLICATIONS MEMBERSHIPS & LLAMA REGISTRATION Duplicate as Needed - Please Print Mail to Nancy Hester, 7295 Churn Creek Road, Redding, CA  96002 Use PayPal (see website - www.packllama.org)  or make check or money order payable to PLTA, Inc.

 

NAME:________________________________________________________________________

Additional children:______________________________________________________________________        

FARM/RANCH:_________________________________________________________________

ADDRESS:____________________________________________________________________

CITY:________________________________________  STATE:________   ZIP:____________

PHONE #:______________________   E-MAIL:__________________________________

oCheck this box if you do NOT want your contact information shared in a PLTA Member Directory.

oCheck this box if you do NOT want your contact information shared with others outside the PLTA membership.

Please Check All Requested Services:

                                                                                                                                                                              (Fill in please)

*FULL MEMBERSHIP:  $30.00 Annual Fee Includes up to two adults (18 years & older) plus all children under age 18 living at the same residence, regardless of whether or not the children own llamas separately from their parents or siblings. If the child's last name is different from the adult's name on the membership, please include their name on this form. Required for owners of llamas participating in PLTA trials and of participants in the PLTA Mileage Club.  Indicate your Primary Interest above -  "Pack Trials" will be designated if no interest is selected. All membership benefits are included at this level.

PLTA LLAMA REGISTRATION:  $10.00 One-Time Fee per animal
Required for all llamas participating in PLTA Pack Trials or documented in the PLTA Mileage Club.

Full Name of Llama:  __________________________________________  DOB: __________

ILR #:  ___________ Sex:    Male    Female    Gelding/Altered    PLTA Llama #: ______

                                                                       (Circle one)                                                           (For Office Use)

Full Name of Llama:  __________________________________________  DOB: __________

ILR #:  ___________ Sex:    Male    Female    Gelding/Altered    PLTA Llama #: ______

                                                                       (Circle one)                                                           (For Office Use)

**ASSOCIATE MEMBERSHIP:  $5.00 Annual Fee    Includes 1 individual only. Associate membership is required for insurance purposes of all non-owner handlers of llamas entered in PLTA events including trials and participants inPLTA Packer's Primer training sessions if an individual does not have a PLTA Full Membership.     

Note: An Associate Membership may be rolled into a Full Membership within the same calendar year by paying the additional $25.00.