NEW BRUNSWICK APPALOOSA HORSE CLUB

MEMBERSHIP APPLICATION

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Name                     ____________________________________________________________

Mailing Address      ____________________________________________________________

                              ____________________________________________________________

 EMAIL ADDRESS      ____________________________________________________________                

Telephone Number __________________________________________

New Membership    _________ Renewal  ___________

Membership Fees         _________  $15.00 Senior – 19 years of age and older

                              _________  $10.00 Youth – 18 years of age and under

                              _________  $20.00 Husband and Wife

                              _________  $25.00 Family – One or two parents and children

                                                                        18 years of age and under

                  (If joining as a family, please give child’s name and date of birth)

Name(s) Age and Birth Date of Youth;

_________________________________________________________________________

_________________________________________________________________________