Asian Turtle Consortium Application Form


Name:_____________________________ Date:_________
Address:______________________________________
City, State, Zip:_________________________________

Contact Information: E-mail________________________
Phone_______________
Fax:__________________
Occupation:______________________________
To ensure your personal privacy we do not share information on members or their collections. This can, however, inhibit networking within our organization. If you do not mind us sharing your membership status with other members in the organization check here (  ). In addition, if you are willing to share information on the species you keep with other members of our organization check here (  ). Finally, if you are willing for us to share your information with other organizations with similar goals, check
here (  ). We will not share your information without your express approval.

List Asian chelonians in your collection and provide numbers of adults (males/females) and immatures. If you know subspecies or geographic origin of stocks this would be very useful. Only list turtles you intend to keep in your collection. An * indicates successful breeding.

Speciesmalesfemales sub adultscomments
 







  







  







  







  







Optional information (use second page or e-mail attachment if necessary):
1. Describe collection security from theft or predation.
2. What arrangements have you made once you are no longer able to care for your animals?
3. Describe your setups (out door ponds, aquaria, enclosure size, lighting, etc.).
4. Are you willing to take on additional stocks? Preferences?
5. Are you currently a member of any turtle organizations or chelonian conservation groups? Please list:
6. Do you have any prior wildlife convictions? ____ If yes describe and provide dates.
7. Any questions?

Return to: Susan Tiedemann at susantiedemann@aol.com
               or P.O. Box 382, Elmsford, NY 10523.
Signature:______________________________________

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