The undersigned herby applies for an Active Membership in the Minnesota Simmental Association, a non-profit corporation, with all rights and privileges and subject to the obligations thereof, as set forth in the Rules and By-Laws of the Association. In consideration
of the agreement to issue such membership, the membership fee is paid herewith.

Name of Membership ____________________________________________________________________________________________

Date ________________ Signature of Applicant ______________________________________________________________________

Home Phone _____________________________________________ Cell Phone ____________________________________________

E-mail Address __________________________________________________________________________________________________

Street or Rural Address _________________________________________________________________________________________

City ______________________________________________________ State & Zip __________________________________________

County ________________________________________________ ASA # ________________________________________________