PLTA APPLICATION MEMBERSHIP & LLAMA REGISTRATION Duplicate as Needed - Please Print         Please Print & Mail to Viv Fulton, 625 County Rd. 24, Sherburne, NY 13460             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:_____________________________________

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

o   Check this box if you do NOT want your contact information shared with others outside the PLTA 

         membership.

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.  All membership benefits are included at this level.

ASSOCIATE MEMBERSHIP: $5.00 Annual Fee Includes 1 individual.  If an individual does not have a PLTA Full Membership, the Associate membership is required for insurance purposes of all non-owner handlers of llamas entered in PLTA events including trials and participants inPLTA Packer Primer training sessions.  Note - An Associate Membership may be rolled into a Full Membership within the same calendar year by paying the additional $25.00.

Parent or Guardian Signature:  _________________________________________________

Signature of Parent or Guardian is required if the handler is under the age of 18 at the time of the events.

MILEAGE CLUB: $10.00 Annual Fee (must also be a Full Member) Includes 1 individual.  Note: Llama must also be registered with PLTA to document their participation in the PLTA Mileage Club but is not required for participation.

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)

 

o  NEW FULL MEMBERSHIP ($30)   or    o  ASSOCIATE MEMBERSHIP ($5)

o RENEWING FULL MEMBERSHIP as PLTA Member #:  ________  ($30)

o  ROLLING ASSOCIATE MEMBERSHIP # _____ INTO A FULL MEMBERSHIP ($25)

o  MILEAGE CLUB ($10)

o  LLAMA REGISTRATION ($10)             TOTAL FEES INCLUDED: $____________