MINIATURE HORSE ASSOCIATION OF ARIZONA        

MEMBERSHIP APPLICATION FORM       Year_______

Fees Pro-rated Semi Annually        Jan—Dec                                         July—Dec

Single Applicant                             $25.00                                              $12.50

Family                                             $30.00                                              $15.00

Youth (use Youth Form)                 $ 5.00                                                   2.00

Lifetime Membership                    $250.00

 

Circle One:   NEW Member        RENEWAL           LIFETIME

Amount $__________for year 20______Paid by:  Cash _______Check ______

Ck# ________

 

Primary Applicant:

First Name:______________________________

Last Name:___________________________

Secondary Applicant:

First Name:______________________________

Last Name: __________________________

Children’s Names: ____________________________________________________________

Address: ____________________________________________________________________

City: __________________________State: _____________________

Zip: _______________

Phone:_____________________________

E-mail Address: ___________________________

Ranch Name: ____________________________________

Web URL: ___________________

I/We approve any of the above information to be printed in the association public web site.

(Please initial)  Yes: ______  No: ______

How many Miniatures do you now own? ___________________________________

List any other organizations or registries of which you are a member: ___________________

___________________________________________________________________________

Please indicate your interests below:  Circle your interests.

Breeding       Charity/Therapy Work       Parades       Pets       Promotion of Show and Events    

Recreational Driving        Showing        Volunteer or Officer

 

________________________________________________

Primary Applicant’s  Signature

 

________________________________________________

Secondary Applicant’s  Signature

 

Mail Application form and Dues to:

MHAA    c/o  Joan Solheim   .   1140 E. Roberts Rd.  .  Phoenix, AZ 85022

Make check PAYABLE to MHAA

OFFICIAL USE ONLY:________________________________________________________

Date Received: _________________________ Date:  Treasurer Received: ____________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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