Northumberland County Riders' Horse Club
Membership Form 2017
Membership Categories: Youth
Membership: 17 years of age and under as of January 1st 2017. Please
Select Membership Type: (X marks the selection) Youth - $ 20.00 __________
Adult - $30.00____________
Team - 20.00___________ |
Please
note: This section must be completed in full to receive a membership
and participant number. Participant's
Name:
__________________________________________________________________ Horse's Name: _______________________________________________________________________ Date of
Birth: D
/ M /YEAR Address: ____________________________________________________________________________ Postal
Code:
_________________________ Telephone Number:
____________________________ Email
Address:
_______________________________________________________________________ Emergency
Contact Name: _________________________Telephone Number:
__________________
Please
remember that your membership is valid from Do you wish
to be on the Northumberland County Riders’ Horse Club email list and
receive club updates, newsletters, minutes of meetings etc.? Yes _____________ No_____________ Do you give
permission to have your name(s) displayed in the Northumberland
County Riders’ Horse Club show results , newsletters, minutes ect. posted on the
website? Yes ______________ No_____________ |
|
Make Cheque Payable to: Northumberland
County Riders' Horse
Club
Mail To: Ashley
Irvine 283 Packer RD Roseneat, Ont. K0K 2X0
Email to: ncrhorseclub@eagle.ca
If
you are buying a
team membership, please list the participants and the two classes
the
participant will collect their points in below.
If participant is showing
more than one horse, please list all names below for extra
numbers.
Name of Participant /Classes ______________________________________ |
Birth Date D / M / YEAR D / M / YEAR D
/ M / YEAR D / M / YEAR |
Horse's name
____________________ |
Office Only No. Given
_____________ |