Upper Peninsula Horsemen's Association
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                                     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

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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

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MEMBERSHIP CHAIR PERSON: ____________________________                       MEMBERSHIP FEES:
                                                                                                                                      CHILDREN 17 & UNDER:  $10.00
                                                                                                                                       ADULTS 18 & OVER:       $20.00


CLICK HERE to print off a membership application
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