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 Membership Application/Renewal Form

 July 1, 2009 - June 30, 2010

 Yes, I would like to apply for new/renewed membership in the Upper Mid-West Rocky Mountain Horse Chapter.  I understand that membership dues are applicable from July1 through June 30 of the following year regardless of payment date within the year.

 $25.00 _______ (New) _______ (Renewal) Single Membership (Individual Adult)

 $35.00 _______ (New) _______ (Renewal) Family Membership (Husband, Wife, Children under 18)

 Name(s) (printed):        

_________________________________________________________________

 Children:          

_________________________________________________________________

 Address:                       _________________________________________________________________
 

_________________________________________________________________
City                                                  State                      Zip Code

Telephone:                       ____________________________________________________

Email Address                  ____________________________________________________
                
If you do NOT wish to have your name and information included on the general membership roster which is privately distributed to Chapter members on an annual basis, check here________.  

 
By tendering payment for membership in the Upper Mid-West Chapter of the Rocky Mountain Horse association (hereafter, "the Chapter") and, if accepted by same, I /WE hereby agree to abide by the Rules, Regulations and By-Laws of the Chapter in all instances and of the International Rocky Mountain Horse Association where applicable.

 
By: (Signature)  

 _____________________________________________________________

 Dated:                         _____________________________________________________________

 Please mail the completed application and a check made payable to:

 The Upper Mid-West Rocky Mountain Horse Chapter
C/O Susan Angell, Treasury
8563 Norris Lane
Capron, Illinois  61012

 

Thank you for supporting this Chapter as we enter into our 11th Year.