WEST VIRGINIA QUARTER HORSE ASSOCIATION
2010 Membership Form
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Nickki Hunt
Membership Secretary
936 Redmud Road
Leon, WV 25123
Phone: 304-895-3063
Fax: 304273-1130
Email: rnhunt@frontiernetnet.net
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ã Renewal Membership ã New Membership
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TYPE OF MEMBERSHIP
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FAMILY -- $25.00
FAMILY MEMBERSHIP includes husband, wife and all children 18 years of age and under, as of January 1. If a
child is eligible to show in youth activities that child is considered a member under a family membership.
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INDIVIDUAL -- $20.00
INDIVIDUAL MEMBERSHIP includes stables, farms and corporations. Only one individual will be a member when a
membership is the name of a stable, farm or corporation, that being the individual whose name and signature
appears as authorized agent on the application.
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YOUTH INDIVIDUAL -- $15.00
YOUTH INDIVIDUAL MEMBERSHIP is just for youth who do not have a family membership. This does not include
membership dues for the West Virginia Quarter Horse Youth Association.
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After June 1 of Current Year Each Fee Goes Up $5.00 for Late Charge
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Name: ________________________________________ Phone: ___________________________
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Complete Address: ________________________________________________________________
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______________________________________________email_____________________________
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NAME |
AQHA ID # |
EXP DATE |
DATE OF BIRTH |
| ADULT |
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| SPOUSE |
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| CHILD 1 |
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| CHILD 2 |
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| CHILD 3 |
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| CHILD 4 |
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WEST VIRGINIA QUARTER HORSE YOUTH ASSOCIATION
2010 MEMBERSHIP APPLICATION
Make Check Payable to: WVQHA
Mail to:Nickki Hunt
Route 1, Box 207
Leon, WV 25123
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Name: ____________________________________ AQHYA ID: __________________ Exp: ____________
Address:___________________________________________Home Phone:___________________________
________________________________________________________Cell Phone _____________________________
Birthdate:__________________________________________ Email_________________________________ |
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