Application for National Junior Holstein Association Membership

Application for National Junior Holstein Association Membership
By submitting this form you agree to follow the rules, regulations and bylaws, and to uphold the standards of Holstein Association USA, Inc. Junior Membership automatically expires on your 21st birthday, but you will be eligible to participate in Junior activities for the remainder of that year. Membership will not be issued to those who have already reached 21 years of age.
SECTION A - CONTACT INFORMATION
Account Number
Name*

First NameMiddle NameLast NameSuffix
Name in which you would like to identify cattle and do business (if different from above, 47 character limit)
Farm Name
Farm Address*

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

Zip Code
The Farm Address is also

Mailing AddressBilling AddressOffice AddressResidence Address
Residence Address (if different from above)

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

Zip Code
The Residence Address is also

Mailing AddressBilling AddressOffice Address
The Residence Address is also

Mailing AddressBilling Address
The Residence Address is also

Mailing AddressOffice Address
The Residence Address is also

Billing AddressOffice Address
The Residence Address is also

Mailing Address
The Residence Address is also

Billing Address
The Residence Address is also

Office Address
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

Zip Code
The Mailing Address is also

Billing AddressOffice Address
The Mailing Address is also

Billing Address
The Mailing Address is also

Office Address
Home Number
Please enter a valid phone number.
Mobile Number
Please enter a valid phone number.
Barn/Office Number
Please enter a valid phone number.
Check the box to your preferred contact number*

Home NumberMobile NumberBarn/Office Number
Fax
Please enter a valid fax number.
Email*
example@example.com
(Holstein Association USA will not share your e-mail address)
SECTION B - OTHER INFORMATION
Birthdate*

MonthDayYear
Date
Prefix (Required only if registering cattle)

Association Bylaws require that each member reserve a prefix unless authorized by the prefix holder to use a family prefix. In this case, all animals must be in one herd. A prefix is not required to take a Holstein Association USA membership, but must be designated if a member wishes to register animals.
Prefix you are authorized to use or prefix choices. Please limit prefix name to 12 letters or less.
Existing prefix or 1st choice
2nd choice
3rd choice
National Junior Holstein Association Membership Dues

National Junior Association membership dues are a one-time $30 fee.
How would you like to pay for your Junior Holstein Association membership?

Pay now with credit cardBill to Holstein Association USA account
Account # to bill membership dues to
If left blank, dues will be billed to the new Junior membership account when it is created
Holstein Association USA, Inc.

1 Holstein Place, PO Box 808, Brattleboro, VT 05302-0808

www.holsteinusa.com | 800.952.5200

©2025 Holstein Association USA, Inc.
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Application for National Junior Holstein Association Membership

SECTION A - CONTACT INFORMATION

SECTION B - OTHER INFORMATION

National Junior Holstein Association Membership Dues