AOA Committee Disclosure Form

Select the committee(s) you are interested in serving on.
Full Name
First NameLast NameTitle
Farm/Ranch Name
Address
Home Phone
Farm/Ranch Phone
Fax
Account Number
Number of years you have owned alpacas?
Number of AOA registered alpacas? Huacaya
Suri
Number of non-AOA registered alpacas? Huacaya
Suri
Number of AOA registered alpacas residing outside the US?
Number of non-AOA registered alpacas residing outside the US?
Do you use additional farm or trade names in the camelid industry?
Do you have a breeding program for alpacas that are not AOA registered?
Do you have partners or business associates in the camelid business?
Do you have partners of co-owned camelids?
Do you have immediate family members or domestic partners in the camelid business?
Do you have non-camelid business partners who are also in the camelid business?
Do you have financial or other interests that might affect, or could be perceived to affect, your impartiality in committee activities?
Have you ever received compensation from AOA for work or services rendered?
Have you ever been disciplined or sanctioned by any of the following camelid organizations; ARI, AOBA, AOA, ALSA, or ILR?
Have you ever been disciplined or sanctioned by any State or Federal Animal Public Health Official or Veterinarian?
Please provide a brief biography about yourself.
Please provide experience that you deem relevant to the committee(s) that you are interested in serving upon.
I hereby affirm that all of the information in this statement is complete and accurate to the best of my knowledge.