2018

2019 Michigan Paint Horse Club Membership Application
Membership

Renewal New Applicant
Type

Individual $20 Family $25
*Family is intended for parent(s) and child(ren).
Who Referred You?

First Name Last Name
Name

First Name Last Name
Date of Birth
APHA Membership Number *
Spouse Name

First Name Last Name
Spouse APHA Membership
Spouse Date of Birth
E-mail *
Phone Number *

Area Code Phone Number

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Youth Name
Youth Date of Birth
APHA Membership
Youth Name
Youth Date of Birth
APHA Membership
Youth Name
Youth Date of Birth
APHA Membership
PLEASE PRINT THIS PAGE PRIOR TO HITTING SUBMIT
- Print and mail form with check to:
Payable to: MPHC
Should be Empty:

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