Yavapai Cowbelles Membership Dues (October 1, 2014 October 1, 2015) $10. 00 Arizona State Cowbelles Membership Dues (Oct. 1, 2014 Oct. 1, 2015) $15. 00

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Yavapai Cowbelles

Membership Renewal / Brand on Scholarship Quilt Form

Dues are due October 1st and delinquent October 31st

Yavapai Cowbelles Membership Dues (October 1, 2014 - October 1, 2015) $10.00 _______

Arizona State Cowbelles Membership Dues (Oct. 1, 2014 - Oct. 1, 2015) $15.00 _______

Please pay American National CattleWomen Dues directly to them: www.ancw.org

ANCW, 9110 E Nichols Ave, Suite 302, Centennial, CO 80112 Phone: 303-694-0313

Name_______________________________________________ Husband’s Name_____________________

Ranch Name (if applicable)_________________________________________________________________

Mailing Address _________________________________________________________________________

City________________________________________________________________ Zip_________________

Email address____________________________________________________________________________

Home Phone___________________________________ Cell Phone_________________________________
The personal information obtained is used for Yavapai Cowbelles’ records. All or part of the information may be published in the Yavapai Cowbelles Membership Directory unless the Secretary is advised otherwise in writing.

2014-2015 Secretary: Mary Helen Ortlieb P. O. Box 451 Humboldt, AZ 86329 mhoogo@yahoo.com

Requirements to have your cattle brand on the Yavapai Cowbelles Annual Scholarship Brand Quilt:

    • Yavapai Cowbelles dues paid no later than Oct. 31st

    • A copy of your current brand certificate from the Arizona Department of Agriculture on file

with the Brand Chairman no later than Oct. 31st

2014-2015 Brand Chairman: Patti Hughes

1422 River Dr.

Dewey, AZ 86327

A $10 fee per brand paid no later than October 31st
Yes, I would like my brand on the Scholarship Brand Quilt (see requirements above) $10.00 _______

New Brands or Corrections--Please draw brand in the box provided:

Name of Ranch _________________________________________

Location (or nearest town)____________________________________

Please send dues and/or brand fee for quilt to: Yavapai Cowbelles

Jolene Miller, Treasurer

P. O. Box 1053

Yarnell, AZ 85362

Thank you, we appreciate your support!

For Yavapai Cowbelles Treasurer Use Only:

Paid cash/check #______________ Date______________ Amount $______________ Local ⃝ State ⃝ Brand fee ⃝

Name/Contact Info given to YCB Secretary ⃝ Name/Contact Info given AZ State Secretary ⃝

Name/Brand Info given to Quilt Producer ⃝ Name/Brand Info given to Brand Chair ⃝

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