Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

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Authorization *

By checking the box, I hereby acknowledge the terms of the membership eligibility above. I will abide by the bylaws, policies and procedures of the Strathmore & District Agricultural Society and authorize the use of my name, address and phone number for Agricultural Society purposes only.