NWVQHA 2009 MEMBERSHIP APPLICATION
(Please list each person which will be on this membership)
(Please list ages of youth on this membership)
NAME:
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
ADDRESS: ____________________________________________ CITY, STATE, ZIP:
__________________
PHONE #: _____________________________________________ E-MAIL:
_________________________ _
MEMBERSHIP STATUS: NEW: _________________________ RENEWAL:
__________________________
| Membership Type |
Amount |
| Family |
$20.00 |
| Individual |
$15.00 |
| Youth |
$10.00 |
NAME & AGE OF YOUTH:
_________________________________
_________________________________
_________________________________
NORTHERN WEST VIRGINIA QUARTER HORSE
ASSOCIATION
NWVQHA 2009 NOMINATION APPLICATION
(HORSE’S OWNER MUST BE A CURRENT MEMBER OF NWVQHA)
HORSE’S NAME: _________________________________________
AQHA#:_______________________
OWNER’S NAME:
_______________________________________________________________________
ADDRESS: ___________________________________ City,State,Zip:
_______________________________
PHONE #: ___________________________________ E-Mail
_____________________________________
NOMINATION FEE: _________________________$20.00
Please make checks payable to
NWVQHA and mail to :
Brenda Ackerman
522 Gravelly Run RD.
McHenry, MD 21541