American Dairy Goat Association

ADGA registry, based on original import records, is your warranty of good breeding and worldwide acceptance.

P.O. Box 865 P Spindale NC 28160
(828) 286-3801 P Fax (828) 287-0476 P www.ADGA.org



Both this form AND a signature authorization form/card
must be filed for issuance of a PIN.


APPLICATION FOR PERSONAL IDENTIFICATION NUMBER
Application will be returned unless a signature authorization card is on file with ADGA or accompanies this form.

You must have a valid PIN issued by ADGA for use with all documents or forms submitted via
ADGA.org or other official website of ADGA, where a signature is required. The ADGA
Personal Identification Number (PIN) is a 5 - 8 digit number that is randomly issued by the
ADGA database. Your PIN serves as the electronic signature for your membership. The
Certificate of Registry/ Recordation, or other processed forms, will be mailed to the owner of the
PIN. The owner of the PIN is responsible for all fees.

Your PIN will be mailed to the address for the membership on file at ADGA. Any address
changes must be filed with ADGA prior to application for a PIN. If you misplace your PIN, a
new one can be issued for a fee of $5.00. It is REQUIRED THAT A SIGNATURE
AUTHORIZATION CARD (ENCLOSED) BE ON FILE WITH ADGA FOR THIS
MEMBERSHIP BEFORE A PIN CAN BE ISSUED. If you do not currently have a signature
authorization on file with ADGA for this membership, please complete and return the enclosed
signature authorization card.


Membership Name ____________________________________ ADGA ID# ________________

Address _______________________________________________________________________

City ___________________________________ State ____________ Zip Code ______________


I hereby authorize the American Dairy Goat Association (ADGA) to accept on all documents or forms
submitted via www.ADGA.org, or other official website of ADGA, the Personal Identification Number
(PIN) issued to the above referenced membership name and identification number in lieu of a written
signature by any person(s) listed on the membership. I do hereby agree, that in consideration of ADGA
allowing the use of a PIN that I agree to hold ADGA harmless from any and all liability which may be
incurred as a result of the use, or misuse by any other person, of said PIN.


___________________________________________________________________________
Authorized Signature for Membership (Required to issue a PIN)


_________________________________________________ ________________________
Print Name Date

PIN20130417
American Dairy Goat Association
Signature Authorization
Membership Name _______________________________________
Authority is hereby given the American Dairy Goat Association to accept
any one of the following signatures on all papers relating to dairy goats
owned by the name above, which I (we) do not personally sign.
Name ________________ Signature _________________________
Name ________________ Signature _________________________
Name ________________ Signature _________________________
Name ________________ Signature _________________________
ADGA Member ID#_______________ Date ___________________
Signature ______________________________________