Center of the Nation Quarter Horse Association

Membership Application

 

Name:__________________________________________

Address:__________________________________

City:___________________ State:____________Zip:_______

 

Phone________________

 

Please indicate the applicant status:

Youtho   Amateur Selecto Amateuro

This membership is for: Individualo Family*o

*If application is for a family membership, please state all family members below.

Name:______________________________________________________________

Relationship to applicant:__________________________Youth:__________________

 

Please enclose $30.00 membership fee: _________________________

 

Send to Becky Johnson, 19472 Nine Mile Rd, Vale, SD 57788

605-456-1176 Home   605-490-7650 Cell