DCHA Membership Information

1. Please type or print when completing this information.
First Name:
   Last Name:
Farm/Company Name:
Address Line 1:
Address Line 2:
City:
   State:
Zip:
Home Phone:
   Work Phone:    
FAX:
E-mail:
Web Site URL:

2. Job Responsibility (check all that apply)

Grower   Dairy Producer   Consultant Researcher

Extension  Veterinarian  Trade Journalist   Industry Representative 

Farm Employee      Other  

3. Age Groups Raised & Farm Capacity (number of head)

Baby Calves (day old through weaned; 300 lbs.)   
Adolescent Heifers (weaned through breeding age)
Springers (bred through pre-calving)                     
Others (e.g., bulls)

4. Financial agreements available (check all that are available)

Contract (Dairy producer retains ownership)
Livestock for sale
Purchase - First option buy back
   Other (please specify)

5. Information Release:

Do we have your permission to have this information printed in the DCHA Membership Directory, which will be made available to DCHA members and can be purchased by nonmembers? 

 Yes No

6. Do we have your permission to post your information on the Members Only section of the DCHA website? 

 Yes No

7. I have the "Raising Quality Replacement Heifers--A Guide to Best Management Practices" and have reviewed it with my staff and veterinarian. 

 Yes No

8. I have participated in the voluntary third-party audit. (DQA Dairy Quality AssuranceSM FIVE-STAR Program.)

 Yes No

Important Note: Unless specifically prohibited, a DCHA member's name, address, and phone number will be printed in the Membership Directory. If this survey is not returned, the information we presently have in our membership database will be used.

DCHA
16020 Swingley Ridge Road
Suite 300
Chesterfield, MO 63017
Phone: 877-434-3377
FAX: 636-449-5051