Membership Form 2009
New York Southern Tier Quarter Horse Association Membership
Application Rates: January 1- December 31, 2009
Please check one:
$________________Family ($30.00) (1vote)
$________________Mr./Mrs. ($25.00) (1vote)
$________________Single ($20.00) (1vote)
$________________Independent Youth ($15.00) (No vote)
New Member________ Renewal_________
NAME:___________________________________________________________________________________ MAILING ADDRESS:_______________________________________________________________________ CITY_________________________________________STATE__________ZIP___________________________ HOME PHONE:_________________________________CELL PHONE:____________________________ E-MAIL ADDRESS:_________________________________________________________________________
There will be a $5.00 point keeping fee for each horse and rider combination. Points will be accumulated from date of payment of membership and point keeping fee(s), not before. There will be no exceptions! ! AQHA Horses must be registered in name of club member. In case horse ownership is transferred, the points are not transferred to the new owner. Points are based upon same horse/rider combination.
NAME 1_________________________ AQHA #______________ Amateur or Nov Amateur
NAME 2____________________________AQHA #_______________ Amateur or Nov Amateur
YOUTH NAME (with last name if different)
Birth Date AQHA # _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ MAKE CHECKS PAYABLE TO: NYSTQHA
Mail to: Leslie Newman, 521 County Route 49, Middletown NY 10940
E-Mail: JONJON@HVC.RR.COM
THERE WILL BE A $ 30.00 SERVICE CHARGE FOR ANY RETURNED CHECK.
HORSE / RIDER COMBINATIONS for Year-End POINT KEEPING (Please Indicate Open Show or AQHA) _____________________________________________________________________________0 AQHA/OPEN _____________________________________________________________________________0 AQHA/OPEN _____________________________________________________________________________0 AQHA/OPEN _____________________________________________________________________________0 AQHA/OPEN _____________________________________________________________________________0
AQHA OPEN DUES:
$________________Family ($30.00)
$________________Mr./Mrs. ($25.00)
$________________Single ($20.00)
$________________Independent Youth ($15.00)
POINT FEES:
$________________(# Horse/Rider combinations x $ 5.00 each)
BALANCE DUE: $__________________
MAKE CHECKS PAYABLE TO NYSTQHA
Mail to: Leslie Newman, 521 County Route 49, Middletown NY 10940
E-Mail: JONJON@HVC.RR.COM
THERE WILL BE A $ 30.00 SERVICE CHARGE FOR ANY RETURNED CHECK.
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