Membership Application
ISLIP HORSEMAN’S ASSOCIATION, INC. MEMBERSHIP APPLICATION
P.O Box 39, East Islip, NY 11730
NAME______________________________________________________________________
SPOUSE____________________________________________________________________
Address__________________________________ City ___________________ Zip ________
Children (List name and date of birth) _____________________________________________
INTERESTS
English ____ Western ____ Gymkhana ____ Drill Team ____ Driving ____ Dressage ____
Other____________________________________________________________________
TYPE OF MEMBERSHIP
FAMILY ($35) ____ INDIVIDUAL ($25) ____ JUNIOR (Under 17 years, $20) ____
NEW MEMBER ____ RENEWAL ____ Do you wish to be on the mailing list ___ yes ___ no
Siganture ______________________________________________ Date ________________
Please note: All membership expire on 12/31.
(i.e If you join in January or October your membership will expire on 12/31 of that year).
P.O Box 39, East Islip, NY 11730
NAME______________________________________________________________________
SPOUSE____________________________________________________________________
Address__________________________________ City ___________________ Zip ________
Children (List name and date of birth) _____________________________________________
INTERESTS
English ____ Western ____ Gymkhana ____ Drill Team ____ Driving ____ Dressage ____
Other____________________________________________________________________
TYPE OF MEMBERSHIP
FAMILY ($35) ____ INDIVIDUAL ($25) ____ JUNIOR (Under 17 years, $20) ____
NEW MEMBER ____ RENEWAL ____ Do you wish to be on the mailing list ___ yes ___ no
Siganture ______________________________________________ Date ________________
Please note: All membership expire on 12/31.
(i.e If you join in January or October your membership will expire on 12/31 of that year).
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