"To stand still is to lose, To move is to gain, To change is to grow"  
--- Gene E. Megiveron
You need Java to see this applet.
Heartland Polish Rabbit Club
Counter
Online Membership Form
Individual Memberships $5 -
* Family Memberships $10 -
  • Family Members must all live at the same address
  • Youth turns adult on their 19th Birthday
  • Only 2 adults per family membership
* Required Fields
*
 Primary Name:
 dob
Member 2 Name:
 dob
Member 3 Name:
 dob
Member 4  Name:
 dob
Member 5 Name:
 dob
Member 6 Name:
 dob
Member 7 Name:
 dob
Member 8 Name:
 dob
*
 Mailing Address:
*
 City:
*
 State:
*
 Zip:
*
 Phone Number:
*
 Email Address:
Website Address:
Polish Varieties raised:
Your other Breeds:
Send payment to:

Bobby George
3654 N. State Rd. 827
Fremont IN 46737-9779
If you want to send
the money online to
us... go here after
the app is filled out!
www.paypal.com
When you click the
above link a new
browser window
will open, please
sign in or create a
new account.
There is a $1.50
handling charge
to recoup the
paypal fees for
using their
services.

1. Select "SEND
MONEY" tab.

2. In the "To"
field, put in
georgebc@gte.net

3. Put the amount
of the transaction
you are paying for
in the "amount"
field.

4. Select US
Currency in the
currency field.

5. Choose goods
or services as the
reason

6. Click the "Send
Money" button.

7. A confirmation
email will be sent
Review your
transaction, make
sure the amounts
are correct.

$10 a year for a
family membership,

$5 for a Individual
membership,

$8 for a patch,

$5 for a
newsletter/website
ad,

Include any extra
amount for a
donation if that is
what you may
choose to do.

Be sure you double
check which
account you are
sending the money
from, please check!
WARNING!
When PAYPAL emails you, they will ALWAYS address you as
your member name, not a generic "Dear Member" etc.

Attempts without your member name is what is referred to as
PHISHING and it is an attempt to steal your log on names,
passwords and bank account numbers... be safe, do NOT follow
links offered from these types of emails! A virus or a Identity
theft is down that road.

Your Friends & Family at Heartland Polish