Suri Network Membership Form

P.O. Box 1984
Estes Park, CO 80517
Phone: (970) 586-5876
Fax: (970) 586-6685
Email: Office@SuriNetwork.org

SURI NETWORK MEMBERSHIP FORM

Thank you for supporting the Suri Network. Membership is $100.00 (US & Canada);
$125.00 all other foreign. Membership will expire one year from the date you join.

WE APOLOGIZE FOR THE INCONVENIENCE, BUT THE "SUBMIT"
ON THIS FORM IS NOT WORKING AT THIS TIME. PLEASE PRINT AND MAIL TO
ADDRESS SHOWN ABOVE.

New MemberExisting Member

First Name
Last Name
Additional First Name
Additional Last Name
Farm Name
Mailing Address
City
State		Zip/PostalCode
Primary Phone Number
Addl Phone Number
Fax Number
Email
AddlEmail
Web Site

How Many Alpacas Do You Own?

Female Suris	Male Suris	Gelding Suris	Total Suris	Female Huacayas	Male Huacayas	Gelding Huacayas	Total Huacayas

METHOD OF PAYMENT

Check Credit Card Card Number

VISA MC Expiration Date

AMEX Name on Card

Security Code

Address/City/State/Zip for Credit Card Statement if different from above

We will also include a few lines of text on the Suri Network web site along with your contact information. (optional)

Items shown in red are required. If not submitting and paying by credit card,
please print and mail along with your check to the address shown above. Thank you!

Check Credit Card		Card Number
VISA	MC	Expiration Date
AMEX		Name on Card
		Security Code