Scott County Regional

Horse Association

2008 Membership Form

 

             I hereby apply for membership in the Scott County Horse Association as follows:

 

             JUNIOR ___________           SENIOR ____________            FAMILY ____________

             $8.00 (18 and under)                     $10.00 (19 and over)                       $25.00*

 

             *Family membership is parents and their children 18 and under.

             4-H members and their families will be offered memberships at 50% off the regular fees.

 

             4-H MEMBER__________               FAMILY INCLUDING 4-H MEMBER__________         

             $4.00 (must be current member)            $12.50 (Includes parents and all children under 18)

 

                                                     Name(s)                                                                Age(s) 

                                        ____________________                                   __________________

                                        ____________________                                   __________________

                                        ____________________                                   __________________

                                        ____________________                                   __________________

                                        ____________________                                   __________________

 

             Address (please use P.O. Box or 911 Address)           

              _________________________________________________________________________

              _________________________________________________________________________

             Phone #            _____________________________________________________________

             E-mail               _____________________________________________________________

 

             How many horses and what breed or type horses do you own?

 

  

 

             What type of horse related activities do you engage in (showing, trail riding,

             team penning, horse pulls, etc.)

 

 

  

             Signature ________________________________________________________________

             Date         ________________________

 

Please return completed application and membership fees to:

 

  Scott County Regional Horse Association

  C/O Herman Hodges

  P.O. Box 204

  Castlewood, VA  24224