Poland Order Form

Name Sr. Member #
Address Jr. Member #
Phone No

Recording Supplies
Qty Item Price Owed
(Qty x Price)
Breeding Certificates (Book of 20) $1.00 $
Registration Applications (book of 50) $10 $
Pedigree Holder $10 $

Fees
Qty Item Price Owed
(Qty x Price)
Life Membership (Sr) $10 $
Junior Membership (under 21 years of age)
Birthday 		$10 $
Maintenance Fee (Due August 1st of each year) $75 $
Type Conference Entry Fees $
Type Conference Pen Fee $
Maintenance Fee ($75) is payable yearly and is good from August 1 to July 31 of each  year. Maintenance Fee payment includes a one year subscription to the Breeders Digest plus a listing in the Breeder's Directory and on our website.

Breeders Digest
Qty Item Price Owed
(Qty x Price)
First Class Subscription  $35 $
Regular 1 Year Subscription $10 $
Regular 3 Year Subscription  $25 $
Canada 1 Year Subscription $25 $
Foreign 1 Year Subscription $50 $
* Labels (mailing) $.07/ea $

All items are cash only unless noted otherwise
* Indicates items that can be charged to your account

Herdsman
Qty Item Price Owed
(Qty x Price)
Sow Productivity Enrollment Fee (one time payment) $25.00  $
Herdsman Performance Program - Growth Record if previously enrolled. Post Weaning Growth and Back Fat - per pig.   $

Herdsman
Qty Item Price Owed
(Qty x Price)
Level One
A litter and all eligible pigs 90 days of age and under

Litters

 $17.50 $
Level Two
A litter and all eligible pigs 90 days of age

Litters

 $40.00 $
Transfers

Transfers within 45 days of sale

 $1 $

Transfers after 45 days of sale

 $2.50 $
Artificial Insemination
All sellers of semen are required to purchase A.I. Certificates from the NSSR. This certificate is then purchased from the Semen Supplier and must accompany each A.I. litter application for recording eligibility

A.I. Certificates

 $10 $
Other Pedigree Work
Change of Name $2.50 $
Duplicates $2 $
Corrections (per pedigree) $2 $
Five Generation Pedigree $5 $
Litter Correction $5 $

Postage And Handling Charges For Supplies
Dollar Value Of Your Order .$.00 - $10 $10.01 - $30 $30.01 and Up
Shipping & Handling Charge $5 $7.50 $10

Total Remittance
Total Of Order Form $
Date

Chester White Swine  Record Association
Box 9758 - Peoria, IL 61612-9758
Phone: (309) 691-0151
Fax: (309) 691-0168

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