Email Membership Form

2008 Membership Application


DATE OF APPLICATION:
NAME:		APHA#:
STABLE OR FARM
ADDRESS
CITY STATE ZIP
PHONE SOCIAL SECURITY NO.

PLEASE CHECK ONE: FAMILY MEMBERSHIP ($40.00)		INDIVIDUAL MEMBERSHIP ($35.00)

IF FAMILY MEMBERSHIP, PLEASE NAME ALL FAMILY MEMBERS: (Please include AMATEUR status if applicable, and birthdate for YOUTH members.)

PLEASE ENCLOSE A PAYMENT FOR MEMBERSHIP IN THE UTAH PAINT HORSE CLUB. THIS MEMBERSHIP COVERS THE CALENDAR YEAR OF JANUARY 1, 2008 THRU DECEMBER 31, 2008
I have read and agree to abide by the UPHC membership requirements and UPHC Rules as listed in the UPHC Rules of Order.



I would like to receive my UPHC Newsletter by Email:		Email Address

To complete your online membership, click SUBMIT and then proceed to Online Payment ONLINE PAYMENT (Secure)