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Farm Bureau Membership Application
NAME;
SOCIAL
SECURITY NO:
SPOUSE S NAME
(If Moolicabh)
ADDRESS:
CITY-STATE-ZIP:
COUNTY;
HOME PHONE:
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BIRTH DATE: MO. /DAY /YR.
FARM NAME:
(It aooHcabh)
TOWNSHIP:
BUSINESS PHONE:
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REG. ASSOC.
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DATE:
Official Rules:
1. ENTRANTS MUST BE A 1995 PFB MEMBER BY NOVEMBER 1, 1994 ALL
MEMBERSHIPS MUST BE SENT TO YOUR COUNTY FARM BUREAU FOR
PROCESSING AND MUST BE IN THE PENNSYLVANIA STATE OFFICE BY
NOVEMBER 1,1994 TO BE ELIGIBLE FOR DRAWING.
2. CONTESTANTS MUST BE AT LEAST 21 YEARS OLD AND A RESIDENT OF
PENNSYLVANIA.
3. OFFICERS, DIRECTORS, STAFF MEMBERS AND THEIR SPOUSES OF PA FARM
BUREAU AND AFFILIATE COMPANIES; EMPLOYEES, AGENTS AND THEIR
SPOUSES OF NATIONWIDE INSURANCE; SAFEMARK DEALERS AND THEIR
SPOUSES: OR EMPLOYEES OF PACMA, INC. AND THEIR SPOUSES ARE NOT
ELIGIBLE TO ENTER.
4. THE WINNER WILL BE ANNOUNCED ON NOVEMBER 15, 1994 AT THE
PENNSYLVANIA FARM BUREAU ANNUAL MEETING.
MAIL TO:
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PENNSYLVANIA FARM BUREAU
P.O. BOX 8736
CAMP HILL, PA 17001-8736
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