U.P.H.A MEMBERSHIP APPLICATION
THIS FORM MUST BE FILLED County: ___________________
OUT COMPLETELY. Date: ___________________
(PLEASE PRINT OR TYPE)
NAME: _________________________________
ADDRESS: __________________________________________________
TELEPHONE: ______________________
ADDRESS CHANGE: YES ____ NO ____ NAME CHANGE: YES ____ NO ____
BIRTHDATE: __________________________ AGE: ____________
HORSE EXHIBITED (FULL NAME) U.P.H.A. NUMBER BIRTHDATE
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
The full name of the horse that appears above must be used entering the horse in Classes all year. Please list any previous registered horse that died or that was sold below:
HORSE U.P.H.A NUMBER SOLD TO
____________________________________________________________________________________
____________________________________________________________________________________
MEMBERSHIP CHAIR PERSON: ____________________________ MEMBERSHIP FEES:
CHILDREN 17 & UNDER: $10.00
ADULTS 18 & OVER: $20.00
THIS FORM MUST BE FILLED County: ___________________
OUT COMPLETELY. Date: ___________________
(PLEASE PRINT OR TYPE)
NAME: _________________________________
ADDRESS: __________________________________________________
TELEPHONE: ______________________
ADDRESS CHANGE: YES ____ NO ____ NAME CHANGE: YES ____ NO ____
BIRTHDATE: __________________________ AGE: ____________
HORSE EXHIBITED (FULL NAME) U.P.H.A. NUMBER BIRTHDATE
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
The full name of the horse that appears above must be used entering the horse in Classes all year. Please list any previous registered horse that died or that was sold below:
HORSE U.P.H.A NUMBER SOLD TO
____________________________________________________________________________________
____________________________________________________________________________________
MEMBERSHIP CHAIR PERSON: ____________________________ MEMBERSHIP FEES:
CHILDREN 17 & UNDER: $10.00
ADULTS 18 & OVER: $20.00
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