2011 Participating Membership _PM_

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					                      2011 Participating Membership (PM)

The 2011 USDF PM year begins December 1, 2010 and ends November 30, 2011. After December 1, the effective date of
membership is the date the form and correct dues are received in the USDF office. Please complete this form and mail or fax it to
the USDF office. PM applications can also be submitted online at Applications submitted online will be processed
the following business day.

Name (please print)                                                               USDF Number                                     USEF Number


City/State/Zip                                                                    Date of Birth (required for youth members)

Primary Phone                           Published Phone (If you are a USDF Official whose number we publish, please provide your preferred number for public lists)

I support USDF in its efforts to go green!
      Please do not mail me a membership card. I will print one from the Web site.
      Please do not send me the USDF Connection magazine. I will access my magazine online.

                                                                                                         IMPORTANT INFORMATION
MEMBERSHIP OPTIONS                                                                                       A hard copy of the USDF Competitor & Member
                                                                                                         Guide can be purchased for $3 at the time of
1-Year Participating - $75                                                                               membership application. All information in the
1-Year Youth Participating - $60                                                                         USDF Competitor & Member Guide can be found
Individuals who have not reached their 21st birthday by 12/1/10                                          online at
5-Year Participating - $300
                                                                                                         Only members renewed by December 31 will
Lifetime Participating - $1500                                                                           receive the 2010 Yearbook.
2011 USDF Competitor & Member Guide - $3
                                                                                                         USDF is not responsible for late, delayed, or
Tax-deductible gift to the Circle of Friends                                                             misdirected mail. USDF may require fees for
                                                                                                         replacement cards for errors reported after 45
Please add $15 for addresses outside the US
                                                                                                         days, or non-receipt of cards reported after 60
TOTAL                                                                                                    days. No portion of membership dues or
                                                                                                         contributions is used for lobbying.
      Check or Money Order (US funds made payable to USDF)                                               For information on rider/handler/owner/horse
      Visa                                                                                               eligibility for specific programs, please visit the
                                                                                                         USDF Web site.
Card Number                                                                       Expiration Date

Name of Cardholder

Billing Address                                                                   City, State, Zip

Signature of Cardholder

                                             4051 Iron Works Parkway, Lexington, KY 40511
Page 1 of 1                        Phone: (859) 971-2277 • Fax: (859) 971-7722 • Web:                                   Member Services /rev. 7/19/10

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