2012 Membership Form - DOC

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2012 Membership Form - DOC Powered By Docstoc
					                            2012 MEMBERSHIP
                            APPLICATION & RENEWAL


Name: _______________________________________________________

       Youth and Date of Birth: ___________________________________

       Youth and Date of Birth: ___________________________________

Ranch Name: _________________________________________________

Address: _____________________________________________________

City, State, Zip: ________________________________________________

Phone: _______________________Fax/2nd Phone: __________________

Email Address: ________________________________________________

Web Address: _________________________________________________

New Member _____ or Renewal _____

Membership Dues are due 1/1/2012 and are valid through 12/31/2012

__$35.00/year - Single Membership, 1 vote, newsletters, all club and show
mailings and full member privileges
__$40.00/year - Family Membership, 2 votes, newsletters, all club and show
mailings and full membership privileges

                                              CREDIT CARDS ACCEPTED
Please send this form and payment to:
NORCAL Miniature Horse Club Secretary-        Card #______________________
Melissa Kovach
1276 4th Street                               Expiration___________________
Lincoln, CA 95648
Email: mtkovach@hotmail.com                   3 digit security code__________

NOTE: 3% processing fee will be added if credit card is used
For more NORCAL MHC info go to http://www.norcalminiatures.com

				
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