Application is hereby made for membership in the National Association of Animal Breeders, Inc. to be issued in the name of
(Name of Company or Individual)
If elected, _______________________________ (I, We) agree to be bound by and abide by the provisions of the Association's Bylaws and policies adopted by its Board of Directors, so long as the applicant is a member of the Association. Applicant hereby certifies that the applicant has received a copy of the Bylaws of the Association and all principal officers and managers of the company have been instructed by the applicant to familiarize themselves with the contents of said Bylaws.
Applicant further agrees to hold the National Association of Animal Breeders, Inc., its Board of Directors, officers, agents, servants and its employees harmless for any damages that may accrue to the applicant, its officers, agents, servants and employees as a result of membership in the Association.
TYPE OF MEMBERSHIP APPLIED FOR
REGULAR ( ) ASSOCIATE ( )
A remittance of $ _________ ($100 for Regular, $125 for Associate) is enclosed for payment of membership application fee. The undersigned applicant (if an applicant for Regular membership) further expressly agrees to file a complete report of semen production and sales in the format that is uniform for all members, and submit payment of dues to the Association in the amount and at the time which may be specified by the Bylaws of the Association and any amendments thereto.
If the applicant applies for Regular membership, the applicant further agrees to enter into an agreement for Semen Identification and Sire Health Auditing with Certified Semen Services, Inc. (CSS) if so required by the Bylaws of the Association or any amendments thereto.
The undersigned, if an applicant for Regular membership, understands that the undersigned is entitled, while a Regular member in good standing of the National Association of Animal Breeders, Inc., to utilize the Association's logo and to publicize the fact that the undersigned applicant is a Regular member of the National Association of Animal Breeders, Inc. If, however, at any time the undersigned Regular membership is terminated for any reason, the applicant, if a Regular member, agrees to cease and desist from any further use of the logo of the National Association of Animal Breeders, Inc. and to further desist from any use, reference, or claim of membership in the Association from and after the time of final termination.
The undersigned, if an applicant for Associate membership, understands the undersigned is entitled, while an Associate member in good standing of the National Association of Animal Breeders, to utilize the association's logo with the word "Associate" listed thereunder. The undersigned understands that it is not proper to utilize the NAAB logo without the word "Associate" beneath it. It is further agreed that subsidiaries of NAAB Associate members are not entitled to use the Associationassociate member must apply for Associate membership in the same manner as other applicants. The undersigned further agrees that, if at any time, the Associate member of the undersigned is terminated for any reason, the applicant, if an Associate member, agrees to cease and desist from any further use of the logo of the National Association of Animal Breeders, Inc. And, further desists from any use, reference, or claim of membership in the association, or to advertise in any way that such person is still a member of the Association after the time of receipt of notice of final termination.
Applicant agrees to file a completed report of Supplemental Information, a copy of which is attached hereto and incorporated by reference as a part of this application form.
The National Association of Animal Breeders, Inc. is hereby authorized to obtain a credit report on the applicant or on the chief executive officer if the applicant is a company.
The undersigned person hereby certifies that he is authorized to execute this application for membership on behalf of the applicant.
Person filing application _________________________________________ (please print)
(Must be Owner or Chief Executive Officer)
Social Security No. of Owner or Chief Executive Officer __________________
Signature _______________________________ Date ______________________________________________
City ________________________________ State _______________ Zip ________________________
Telephone: (Area Code) _______ (Number)
Fax: (Area Code) ________(Number) ___________________________________
Email Address: ________________________________________
The National Association of Animal Breeders, Inc. (NAAB) does hereby (ACCEPT) (REJECT) this application for membership on this __________ day of
National Association of Animal Breeders, Inc.
(To be executed in duplicate)
Note: The following information is submitted to supplement applicant's application for membership in the National Association of Animal Breeders (NAAB) and is incorporated by reference as a part of said application.
Applicant (please print) Date
I. NAMES AND ADDRESSES OF OWNER(S):
II. TYPE OF ORGANIZATION:
( ) Corporation ( ) Partnership ( ) Cooperative ( ) Individual
III. BUSINESS ACTIVITY
A. Semen Production and Sale
1. Number of bulls you own
2. Breed(s) of bulls you own
3. Number of units of semen sold and marketed through insemination service and direct semen sales during your last fiscal year.
United States Foreign
Beef ____________ Beef _____________
Dairy ___________ Dairy ____________
4. In what states and countries do you sell semen?
5. Where do you obtain semen other than from your own bulls?
6. Number of units of semen purchased during your last fiscal year:
Beef _____________ Dairy _____________
7. How many technicians do you employ?
8. Business activities other than production and sale of semen:
B. Custom Freezing
1. Number of units of semen custom frozen during your last completed fiscal year:
Beef _____________ Dairy _____________
2. In what states do you provide service?
C. Date business activity initiated
IV. ADMINISTRATIVE AND MANAGEMENT PERSONNEL
B. Domestic Marketing
C. International Marketing
D. Beef Sire Evaluation
E. Dairy Sire Evaluation
H. Editor and Publicity
I. Field Services
K. Other (Please specify)
V. OFFICERS AND DIRECTORS (List names and addresses)
B. Vice President
VI. SUITS OR JUDGMENTS
A. Have any suits or judgments been filed against applicant? Yes ( ) No ( )
B. If yes, attach summary of nature and date of such suit or judgment, and court involved.
VII. CRIMINAL CONVICTIONS
A. Has applicant or any of its principal officers been convicted of a felony? Yes ( ) No ( )
B. If yes, attach summary of nature and date of such conviction, and court involved.
A. Business References
B. List two or more persons affiliated with NAAB REGULAR MEMBER ORGANIZATIONS familiar with your operation as references. Please obtain approval from all persons listed. List name and address of each AI organization.
National Association of Animal Breeders
PO Box 1033
Columbia, Missouri 65205
Tel: (573) 445-4406
Fax: (573) 446-2279