Membership Application Membership Type* General Membership $25 Individual/Family Sponsors Business Sponsors Choose Sponsor Level* Bronze $35 Silver $50 Gold $100 Platinum $250 Diamond Choose Business Sponsor Level Bronze $100 Silver $250 Gold $500 Platinum $1000 Diamond $1500 Name*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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone #Cell Phone #Business Name Business 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 By Additional Donations:Ag Farm FFA Jacket Quantity Price: $75.00 Quantity Scholarships Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name