VHSA MEMBERSHIP APPLICATION
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(In order to print this application, you must click anywhere on the application
before requesting printout)
___________________________
(DO
NOT WRITE IN THIS SPACE)
(E)
(This
form must be mailed to the VHSA office with your check; or you may give it to
the show secretary of any VHSA recognized show.
Sorry credit cards are not accepted.)
Virginia Horse Shows Association, Inc.
32
Ashby Street #204 - Warrenton, VA 20186 *** (540) 349-0910
MEMBERSHIP
APPLICATION
INDIVIDUAL
MEMBERSHIP:
MEMBERSHIP
CATEGORY:___ REGULAR(RATED);___ ASSOCIATE(LOCAL); OR ___BOTH
Name:_____________________________________________________________________
Address:__________________________________________________________________
City:_________________________________________County:_____________________
State: ________________________________
Zip Code:____________________
Telephone: (___) ___________ (HOME)
Date of Birth:____________________
(___)
___________ (WORK) My
Breed Interest:________________
Individuals who show at rated horse shows should become
"Regular" members, individuals who show only at
"Associate" horse shows should become Associate members.
Individuals who show at both "Regular" and "Associate"
horse shows should become "Regular" members.
REGULAR
PROGRAM MEMBERSHIP FEES
ASSOCIATE PROGRAM MEMBERSHIP FEES
Annual
Dues:
(NOTE:
Not eligible to accrue
points at rated shows.)
Senior Membership $40.00 ______
Annual Dues:
Junior Membership $30.00 ______
Senior
Membership $25.00
______
Life
Membership $400.00
______
Junior
Membership $20.00
______
(Horse
and Owner must be registered with the VHSA to accrue points for Year-End
Awards Program)
______________________________
(DO
NOT WRITE IN THIS SPACE)
FARM/STABLE/CORPORATION
MEMBERSHIP
Farm/Stable/Corporate
Name:_____________________________________________________________________
Owner: _______________________________________
VHSA No.:_________________
Address:______________________________________ County:
__________________
City:________________________ State:_____________ ZipCode:______________
Telephone: (____) ____________
(HOME) Date of
Incorporation:___________
(____)
____________ (WORK)
I
hereby certify that the above information is correct and that I am the owner
or agent for the aforementioned Farm/Stable/Corporation.
DATE:_________
SIGNATURE: ___________________________________________
REGULAR PROGRAM MEMBERSHIP FEES
ASSOCIATE PROGRAM MEMBERSHIP FEES
Annual Recording Fee $ 50.00 _____ (NOTE:
Not eligible to accrue
Lifetime Recording Fee $250.00 _____ Annual Recording Fee $25.00
______
NOTE: ANNUAL MEMBERSHIPS
EXPIRE NOVEMBER 30TH