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Dusty Boots Membership Form

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Dusty Boots Riding Club Membership Application

DATE:_________________

_________FAMILY-$20.00 (Parents & Family memb. under 18) (Youth
                must be uder family membership)
_________SINGLE-$15.00

Please list names as they will be on the entry cards all show season.
 
NAME:_________________________________SPOUSE:__________________

ADDRESS:________________________________________________________

_________________________________________________________________

CITY:___________________________________STATE:________ZIP:________

PHONE:________________________________

EMAIL:_________________________________


CHILDREN:________________________________BIRTHDATE:__________

CHILDREN:________________________________BIRTHDATE:__________

CHILDREN:________________________________BIRTHDATE:__________

CHILDREN:________________________________BIRTHDATE:__________

Make checks payable to Dusty Boots Riding Club, Inc. and return
application along with check to Dusty Boots Riding Club, Inc.,
P.O. Box 875, Ashtabula, Ohio  44005-0875.
*Membership iincludes N.E.O.H.A. Rule Book and subscription to the
CORRAL" only if paid by March 1 
NOTE: THIS DOES NOT INCLUDE HORSE SIGN-UP FEE FOR N.E.O.H.A. POINTS.


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