MEMBERSHIP APPLICATION FORM

Western Huckleberry & Bilberry Association (WHBA)

The mission of the Western Huckleberry and Bilberry Association is to create a vital, thriving industry built around huckleberries and bilberries through information, education, and networking.

Calendar Year Dues: $25 for 2006

PRIMARY MEMBERSHIP CATEGORY:

(Check all that apply. Please indicate PRIMARY category with double check mark)

___ Producer (Grower, Land Manager)
___ Harvester (Picker, Wildcrafter)
___ Processor
___ Wholesale (Broker, Wholesaler, Distributor)
___ Value-Added Retail (Retailer -Online &/or Storefront, Manufacturer's Representative)
___ Research, Extension & Development

                   (Non-Profit, Research, Extension, Technical Assistance,

  Economic-Resource-Sustainable Development)

Contact Information -- Please Print Clearly:                                                                                         

Contact Name(s):            ____________________________                     Comments:

Company or Business:     ____________________________

Mailing Address:             ____________________________

                                      ____________________________

City, State Zip                 ____________________________

Phone:                            ____________________________

Cell phone:                      ____________________________

FAX:                              ____________________________

Email address:                 ____________________________

Email address 2:              ____________________________

Web site URL:                ____________________________

Please mail with check to:         Western Huckleberry & Bilberry Association

                                                c/o Clearwater RC&D Council, Inc

                                                PO Box 9576    Moscow, ID 83843

Or FAX application to: (208) 883-4239 

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