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Name
______________________________________ State____ Zip Code
_____________________
Address
_______________________
______________________________________________
Phone Number E-mail address
Regular Membership ($15.00) [ ]
Life Membership (One ten-frame colony of honey bees w/30 frames or
cash equivalent) [ ]
Contribution to Research: $___________________
Send form and payment (checks payable to F.S.B.A.)
to: Bert Kelley,
Treasurer,
115 Patten Heights Street,
Lakeland, FL 33803-2248,
phone/fax
(863) 644-6944,
E-mail <KelleysApiaries@aol.com>
Please provide the following information:
Sideliner (0- 50 hives) [ ] Commercial (50 hives or more) [ ]
Brief description of your operation:
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