Dusty Boots Riding Club Membership Application
Due January 1

DATE: ________________

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

_________Corral - $5.00
(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  44004.
*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.