Bill to:

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Email:

Send to:

Is the send address the same as the billing address?
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First Name:

Last Name:

Address:

City:

State:

Zip Code:

Do we have permission to list the member’s first name and state on our website as a special friend of our llamas?

Yes

No

Method of payment:

PayPal(preferred) Check Money Order

PayPal payments can be made to enkagape@aol.com

Send your check or money order to: Agape Hill Farm 618 Houston Hill Road Hardwick, VT 05843.

Membership is effective when payment is received.

Gift membership?

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