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Silver State Miniature Horse Club
Membership Application
Date: ___________________________ Membership Year: _________________
Last Name: ______________________ First Name: _______________________
Additional Name(s): _________________________________________________
_________________________________________________
_________________________________________________
Address: ___________________________________________________________
City: ___________________________ State: _____ Zip Code: _____________
Telephone: _________________________ Cell: __________________________
E-mail Address: ____________________________________________________
Web Site: _________________________________________________________
Membership Type: [ ] Individual (1 vote) $15.00 per year
[ ] Family (2 votes) $25.00 per year
[ ] Youth (no vote) $10.00 per year
Instructions:
Print this page, fill out the form and attach a check for the proper amount.
Mail application to: Silver State Miniature Horse Club
Attention: Linda Love, Treasurer
PO Box 19404
Jean, NV 89019
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