

Names: _________________________________________________________________________
Address: _________________________________________________________________________
City: ________________________________ State: _______ Zip: ________________________
Phone #: ________________________________ Cell #: ________________________________
Email: __________________________________ May we list address on club roster?
Yes / No
Do you wish to be notified of special events or schedule changes via email?
Yes / No
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Membership Types:
Family Membership / $45. (#adults ____ #juniors ____)
(family membership is limited to parents or guardians and children under 18)
Adult Membership / $35.
Junior Membership / $25. (birthdate: __________________ must be under 18 yrs)
Senior Membership / $25. (must be over 65 years)
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New Membership / 2008 -or-
Renewal Membership / 2008
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Names |
Birthdate |
Wedding Anniversary Date |
________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
| New Member Sponsored by: |
| Make checks payable to . . . . . Gold Country Horsemen’s Association |
| Mail to . . . . . . . .. . . . . . . . . . . . . . .
. .P O Box 1586 |