
	March 30, 2012 - 34th Annual Newport Pig Cookin' Contest • April 13, 2012 - Spencer-Penn BBQ Cookoff

Membership Application

Please note required fields are marked with an asterisk(*).

First Name*

Middle Name

Last Name*

Preferred Mailing Address: *
Home Work

Work Address 1

Work Address 2

City | State | Zip

Home Address 1

Home Address 2

City | State | Zip

County of Residence*

Telephone (Work)

Telephone (Home)*

Telephone (Cell)

Fax

E-mail Address*

Check all that apply:

Producer

Contracting:

Contracting For:
Job Title

Independent
(including Genetics/SS, or Weaner/Feeder Pig Producers)

Farm Name

Employee of Production Company/Integrator/Contract Grower

Company/Integrator/Farm Name
Job Title

Allied Member

Any individual, partnership, firm or corporation who is involved in a company or industry that is allied with or otherwise supportive of pork production in North Carolina.

Affiliation
	(Examples include Extension, Education, Animal Health, Financial Services, etc.)
Employer
Job Title

Other Member

How are you related to the pork industry?