**After June 1 of current year, each fee increase by $5 as late charge**

______ FAMILY $25 - Includes husband, wife and all children 18 years of age and under, as of Jan 1. If child is eligible to show
in youth activities, that child is considered a member under a family membership

_____ Individual $20                                                                                                      ______Lifetime Individual $150

Includes stables, farms and corporations. Only one individual will be member when a membership is the name of a stable,
farm,or corporation, that being the individual whose name and signature appear as authorized agent on the application.

___Youth individual $15        For Youth who does not have a membership included in a family membership . This does not
include membership dues for the West Virginia Quarter Horse Youth Association. Please see WVQHYA membership for
at the bottom of this page.

NAME _____________________________________________________________     PHONE ___________________________

COMPLETE ADDRESS ___________________________________________________________________________________

                                         (RR / PO BOX / STREET)                                           ( CITY / STATE / ZIP)

EMAIL ADDRESS ________________________________________________________________________________________

NAME HERE

__________________________ AQHA ID # _______________ EXP DATE _____________DATE OF BIRTH______________

SPOUSE

__________________________ AQHA ID # _______________ EXP DATE ____________ DATE OF BIRTH ______________

CHILDREN                                AQHA ID #                                 EXP DATE                         DATE OF BIRTH

1. _______________________________________________________________________________________________________

2. _______________________________________________________________________________________________________

3. _______________________________________________________________________________________________________

                                                 WEST VIRGINIA QUARTER HORSE YOUTH ASSOCIATION                                            

WVQHYA MEMBERSHIP - $5                                                                                   MAKE CHECK PAYABLE TO: WVQHYA

Youth must also be a member of WVQHA                                                                                  936 Redmud Road

NAME ______________________________________________ AQHYA ID # _________________________ EXP __________

ADDRESS ______________________________________________________________________________________________________

BIRTHDAY __________________________________________ PHONE # __________________________________________

FOR FURTHER INFORMATION PLEASE CONTACT : NICKKI HUNT, 936 REDMUD ROAD, LEON, WV 25123   rnhunt@frontiernet.net