2019 - Page 127

THE AMERICAN MINIATURE HORSE ASSOCIATION, INC. 5601 S Interstate 35 W  Alvarado, Texas 76009 (817) 783-5600  FAX (817) 783-6403 http://www.amha.org MEMBERSHIP APPLICATION Please check the appropriate Membership, complete the information below, and return. Applicants agree to abide by all the Rules, Regulations and decisions of the AMHA, its Officers and Directors or its appointees. USA Annual Membership * 3 rd Member or Subsequent in household ** Youth Membership*** Associate Membership ****  $70.00  $35.00  $10.00  $70.00 3 Year Membership 3 rd Member or Subsequent in household  $210.00  $105.00 CANADA INTERNATIONAL  $70.00  $35.00  $10.00  $70.00  $70.00  $35.00  $10.00  $70.00  $210.00  $105.00  $210.00  $105.00 ____________________________________________________________________________________________________ * Annual Membership doesn’t expire until one year from the month payment is received. ** Must reside at same address as Member. *** Valid until youth age limit is exceeded as defined in the AMHA Rulebook (Article IV–Section 2–D) ****Non-AMHA Horse Owners Only NOTE: MEMBERSHIP INCLUDES SPOUSE ONLY IF REQUESTED. For Show Purposes please include sex and birth date (Sex and birth date required for Youth) Please Print: _____________________________________________________ Primary Member Name  Male  Female Birth Date _____________ MM/DD/YY _____________________________________________________ Spouse Name  Male  Female Birth Date _____________ MM/DD/YY _____________________________________________________ 3 rd Member or Subsequent at same address  Male  Female Birth Date _____________ MM/DD/YY _____________________________________________________ Youth Name  Male  Female Birth Date _____________ MM/DD/YY  Male  Female Birth Date _____________ _____________________________________________________ Youth Name MM/DD/YY Private  Check to have AMHA not publish your address (this is independent of Public Phone) __________________________________________________ _______________________________________________ Address City / State /Zip/Country _______________________ Public Phone (Leave blank for unlisted) ___________________________ Daytime Phone - AMHA use only (Can be same as public phone) ________________________________________ E-mail Address PLEASE MAKE ALL PAYMENTS IN US FUNDS ____ Credit Card ____Check Enclosed Credit Card #: _________________________________ Expiration Date: ____/_____ CVV: _________ Name on Card: ________________________________ Signature: _______________________________