2011 CDCTA Early Bird Membership Form

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                          2011 Membership Form and Early Bird Special

                              Join Now and Pay 2010 prices for 2011!

           $35/year for individual member; + $20 for each additional family member
                              if received before November 1, 2010
            Mail to CDCTA Roster Coordinator: Sarah Patrick, 4623 County Road 304, Fulton, MO 65251
                    Membership Year runs December 1, 2010 – November 30, 2011*

The Columbia Dressage & Combined Training Association (CDCTA) is a United States Dressage Federation
(USDF) Group Member Organization (GMO). By joining CDCTA you become a USDF GMO member. As
such, CDCTA sends $20 of an individual membership and $10 per additional family member to USDF for each
supporting family member. *2011 CDCTA prices after November 1: $38/year for individual member; $22 for
each additional family member


Member name: _________________________________Date of Birth* __/__/__ Renewal? Yes No

Email address to receive CDCTA and USDF updates: _________________________________

Supporting family member name(s): Please use additional forms, as needed

1. _________________________________________Renewal? Yes No; Date of Birth__/__/__
Email address: ___________________________________________

2._________________________________________Renewal? Yes No; Date of Birth __/__/__
Email address: ___________________________________________

3. ________________________________________Renewal? Yes No; Date of Birth __/__/__
Email address: ___________________________________________

Street Address: ________________________________________ City: ___________________
State: _____ Zip code: ______________ Daytime telephone: ___________________ Evening telephone:
_________________________

Do you wish to receive your CDCTA newsletter by email ___ or mail ___?



Did someone encourage you to join CDCTA? If so please list here: _____________________________
Names will be entered into a drawing for a free one-year membership.
       *
       Date of birth information is requested to appropriately place members in CDCTA and USDF
       awards categories



 Thank you for your membership! The roster is due to USDF by November 1 and will be updated on an on-going
                                        basis throughout the year.

				
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