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| 2003 WV Paint Horse Club Membership Form |
| (check one) _____ New Member _____ Renewal ______Address Change |
| Membership Dues (check one) |
| ____Individual $20.00 ____Family $40.00 (husband, wife & children under 18) ____Youth $15.00 (18 and under) |
| First Name:____________________ Last Name:________________________APHA # _________________ Will you be showing as an amateur? YES NO Farm Name:____________________________________ List of Youth Name(s) and Birth Date(s) 18 yrs. & under that are showing: __________________________________________________________________________________________ __________________________________________________________________________________________ Mailing Address: ____________________________________________________________________________ City________________________State_____________ Zip ___________________ Phone: (_____) ____________________________ Make Check Payable to: WV Paint Horse Club Print out Form and mail Check and Form to Trudy Pethtel, Rt 2 Box 431, St. Marys, WV 26170 |
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