NORTHERN WISCONSIN PAINT HORSE CLUB
MEMBERSHIP FORM – 2010
Please Check One Type of Membership
Open to 2 adult members and unlimited family your members all living in the same household. Only adult members will be entitled to vote. Each adult member is entitled to one vote.
Open to anyone 19 years or older or a business. Each adult member is entitled to one vote. A business is entitled to one vote.
Open to anyone 18 years or younger. No voting privileges.
Ranch Name________________________________________________________________________________________
(If horses are registered in a ranch or business name)
Name _________________________________________________________________APHA#______________________
Spouse ________________________________________________________________APHA#______________________
Youth _________________________________________________________________APHA#______________________
Youth _________________________________________________________________APHA#______________________
Youth _________________________________________________________________APHA#______________________
Address ___________________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
Phone Home (_____) ________________________________Cell (_____) _____________________________________
Email Address ______________________________________________________________________________________
Signature __________________________________________________________________________________________
Please make checks payable to Northern Wisconsin Paint Horse Club or NWPHC
Mail to: Sheryl Pullin-1187 State Road 48-Luck-WI-54853
For Office Use
Date Received
Amt Received
Check #_____________ Cash__________
Received by________________________