Membership Application Membership Type*General Membership $25Individual/Family SponsorsBusiness SponsorsChoose Sponsor Level*Bronze $35Silver $50Gold $100Platinum $250DiamondChoose Business Sponsor LevelBronze $100Silver $250Gold $500Platinum $1000Diamond $1500Name*As you would like it to appear on Membership Lists. First and Last Name Email* Enter Email Confirm Email Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone #Cell Phone #Business NameBusiness Phone #Want to Get Involved?(Check all boxes that apply) Volunteer to help at Fundraisers Will donate auction items for Dinner Dance Volunteer for FFA Chapter Projects Comments (i.e. skills, volunteering interests, donations, equipment to borrow)Name of Member/Student Referred ByAdditional Donations:Ag Farm FFA Jacket Price: $75.00 Quantity: Scholarships Total $0.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name