Heartland Miniature Horse Club Membership Application Form
(membership(s) valid November 1 through October 31 of current year)
Name
_________________________________Spouse _________________________
Farm Name ____________________________________________________________
Youth
Member’s Name ___________________________ Date of Birth _____________
Youth Member’s Name ___________________________ Date of Birth
_____________
Youth Member’s Name ___________________________ Date of Birth _____________
Youth Member’s Name ___________________________
Date of Birth _____________
Address _______________________________________________________________
City ____________________________________
State ____________ Zip _________
Telephone _______________________________ Cell __________________________
Fax: ______________________________
Website: _____________________________________________________________
Email Address: _________________________________________________________
*If
characters in your email address are hard to distinguish between letters & numbers,
please note so that we have an accurate email
address.
Family Membership $25 ___________members =_________
Includes family members age 18 or under on, or before, December 1st of the current competition year. (i.e., children,
grandchildren, step children, step grandchildren, nieces, nephews, those under legal guardianship, other relationships as allowed
by AMHA and/or AMHR) Member/Spouse get 2 votes at the annual meeting.
Regular/Individual Membership $20 _________members =_________
Single Membership gets 1 vote at the annual meeting. ( One vote at the Annual Meeting)
Youth Membership(s) $10 __________members = _________
Not included in the Family Membership above. Age 18 or under on, or before, December 1st of the current competition
year. Must be sponsored by an Adult HMHC Member.
Sponsored By __________________________Youth get no vote at the annual meeting.
Send
form, with your payment (payable to HMHC) to:
Valerie Cuthbertson, 2284 27th Ave. Canton, KS 67428
Welcome to the Heartland Miniature Horse Club
www.heartlandmhc.com