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The Arkansas Paint Horse Club's Membership Information Form

ARKANSAS

PAINT HORSE CLUB

Fees:  $20/First Member

$5/Each Additional Member (same household)

(Membership Term:  January 1 - December 31)

2009 Membership Information Form

First Member Information ($20.00):

Member (1):

APHA ID# (if applicable):

Address:

Phone:

E-mail:

(Note:  Member or Additional Members should list Amateur/Youth ID/or Date of Birth.)

Additional Member Information ($5.00):

Member (2):

Amateur/Youth ID# or DOB:

Additional Member Information ($5.00):

Member (3):

Amateur/Youth ID# or DOB:

Additional Member Information ($5.00):

Member (4):

Amateur/Youth ID# or DOB:

Additional Member Information ($5.00):

Member (5):

Amateur/Youth ID# or DOB:

Must be a club member to be eligible for club awards.

Return Completed Form to:

Rick Witcher

71 Witcher Drive

Cabot, AR 72023