ICLA Members Form

ICLA DUES -- NEW MEMBER
(please print all information clearly so e-mail can be used)

Name:_________________________________________________________

Flock Name:____________________________________________________
Address:_______________________________________________________
City:_____________________________________ Zip:__________________
Home phone number:________________________
Cell phone number:_________________________
E-mail address:____________________________

Membership runs from Jan 1 through Dec 31. Dues are to be paid by Jan 1.
Mail this sheet with your check for $50.00 for 2012 dues to

ICLA
c/o Duane Sprouse
PO Box 43
Keota, IA 52248

For more information...
Sprouse Family Club Lambs
P.O. Box 43
Keota, IA 52248
Phone 641-636-2115
Email: dupat@cloudburst9.net