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Membership Form 2010
New York Southern Tier Quarter Horse Association Membership
Application Rates: January 1- December 31, 2010
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, P.O. Box 714, New Hampton, New York ,10958.
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, P.O. Box 714, New Hampton,
New York, 10958.
E-Mail: JONJON@HVC.RR.COM
THERE WILL BE A $ 30.00 SERVICE CHARGE
FOR ANY RETURNED CHECK.
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