Application for National Adult Membership, Associate Breeder Status, or Account

Application for National Adult Membership, Associate Breeder Status, or Account
IndividualPartnershipCorporateSyndicateAssociate Breeder (for those with religious beliefs prohibiting membership)Account Only (Complete Sections A and D. Account holders to not receive discounts on registrations unless membership fee is paid)
SECTION A - CONTACT INFORMATION
Holstein Account Number (if known)
Individual Name*
Partnership Name*
Corporate Name*
Syndicate Name*
Associate Breeder Name*
Name*

If Partnership, list additional partners below

Rows	Partners
Name
Name
Name
Name

Name in which you would like to identify cattle and do business (47 character limit)
Farm Address*

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

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

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

Zip Code
Mailing AddressBilling AddressOffice Address
Mailing AddressBilling Address
Mailing AddressOffice Address
Billing AddressOffice Address
Mailing Address
Billing Address
Office Address
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState (use 2 letter abbreviation)

Zip Code
Billing AddressOffice Address
Billing Address
Office Address
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Barn/Office Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home PhoneMobile PhoneBarn/Office Phone
Email (Holstein Association USA will not share your email address)*
example@example.com
Fax
Please enter a valid fax number.Format: (000) 000-0000.
Section B - Other Information
The Pulse

The Pulse, Holstein Association USA's quarterly member magazine, is mailed free of charge to active Association members.
OnlineIn the Mail
SECTION C - MEMBERSHIP INFORMATION & FEES
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 needs to 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
YesNo
If yes, which State Association do you belong to?
National Membership $45

*National membership is separate from your State Association membership dues

Partial Year Membership (Applied July - October) $25
Pay now with credit card using secure online paymentBill to my Holstein Association USA account
My Products
prevnext( X )
National Membership
Applied January - June

$40.00 Quantity

Partial Year Membership
Applied July - October

$25.00 Quantity

Total

$0.00
SECTION D - MEMBERSHIP AGREEMENT
AGREEMENT: As a condition of being admitted as a member of Holstein Association USA, Inc., or as a condition for a non-member to do business with Holstein Association USA, Inc., the applicant agrees to accept and be bound by the Constitution and Bylaws, and rules and regulations of the Association as they now exist and as they may hereafter be amended. This agreement applies for membership this year and in any future year. The applicant agrees to be responsible for the accuracy of all information on registration and transfer applications submitted by the applicant. In addition, the applicant agrees that all records on animals owned by the applicant, whether maintained by the applicant or by others, including production records, may be obtained from DHIA and/or the responsible DRPC and used by Holstein Association USA, Inc. in its programs. The person signing this application as an individual or as an official representative of an entity, acknowledges the inclusiveness of this application for membership and agrees personally and/or on behalf of the represented entity that this authorizes Holstein Association USA, Inc. to accept and process any and all applications relating to registration, transfer and programs without a signature, regardless of how or by whom submitted.
Signature of Applicant(s): (Or duly authorized representatives)
Signature of primary contact*

Clear
Printed Name of primary contact*
Date*

MonthDayYear
Date
Other authorized representatives
Signature

Clear
Printed Name
Date

MonthDayYear
Date
Signature

Clear
Printed Name
Date

MonthDayYear
Date
Signature

Clear
Printed Name
Date

MonthDayYear
Date
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 Adult Membership, Associate Breeder Status, or Account

SECTION A - CONTACT INFORMATION

Section B - Other Information

SECTION C - MEMBERSHIP INFORMATION & FEES

SECTION D - MEMBERSHIP AGREEMENT

Signature of Applicant(s): (Or duly authorized representatives)