Connecticut Poultry

Association, Inc.

The Voice of Connecticut's Poultry Industry
Enclosed is my contribution of :

$10 $25 $50 $100 $500 $1000 Other
Please apply my contribution to :
General Fund

 Julius Fleischmann Scholarship Fund
Robert DeCloux Research Fund

 Joe Goldberg General Purpose Fund

Please make checks payable to:Connecticut Poultry Association.

Please return checks to the Connecticut Poultry Association, 1084 Shennecossett Road, Bldg. 19, Groton, CT 06340.

Name:


Street:


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Zip:


Telephone (Home):


E-mail:


Web site:

Farm or Company:


P.O. Box:


State:





Telephone (Work):


Fax: