St Clair County
Arabian Horse

Association

--2006 APPLICATION FOR MEMBERSHIP--

Date Joined:____________________ Member Number:______Renewal □ yes □ no

Name: ________________________________________Phone: __________________

Address: _______________________________________________________________

City: ___________________________ State: __________ Zip: ___________________

List All Family Members:

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

List All Riders:

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

Name: _________________________ Age: ___________ Birthdate: ______________

I assume full responsibility for accident and/or injury to myself, my family or my horses while participating in the S.C.C.A.H.A.

Signiture of Adult voting member _________________________ DATE: ___________

FEE:
$20.00 per family if paid by December 31, 2005
$30.00 per family if paid after January 1, 2006
Make checks payable to SCCAHA

Mail Form to:

Bridgette Bradley
3065 Conrad Dr.
Clyde Twp., MI 48049
(810) 982-0321

Do you want your phone number in the SCCAHA Directory YES______ NO_______