Membership Application
please print and mail
Renewal New Member (circle one)
Please fill in EVERY blank, we need the info.
Name____________________________________________________
Phone Number (______) ___________________
Address__________________________________________________
email___________________________________
City_________________________________
County of residence_____________________
State______ Zip________________
Name of Local Association_____________________________
Tennessee Apiaries Registration Number________________
Local Association Position (Pres), (VP) etc.________________
Local association TBA Director( ) or alt. Director ( )
Number of Colonies_______
Years as beekeeper_________
The year you joined Tennnessee state association_____________
Are you willing to move your bees for pollination? ________
If so, how many hives? _____________
Membership Type (Please check one)
1 Year Membership Single ($10) ______ Family ($22) ______ (Up to 4 family members)
Names____________________________________________________________________
2 Year Membership Single ($18) ______ Family ($40) ______ (Up to 4 family members)
Names____________________________________________________________________
3 year Membership Single ($26) ______ Family ($60) ______ (Up to 4 family members)
Names____________________________________________________________________
Gold Member Single Only ($175) - _______ (Dues Paid for Life of Member)
Please mail form and dues to:
Edward B. Riggs, Treasurer
PO Box 33
Harriman, TN 37748-0033