2019 - Page 128

Membership Form Please note: As of 01.01.08, all AMHyA memberships are Lifetime Memberships. They are $10 and will be valid until 12.31 of the year the youth turns 18. Youth Memberships do not have Registration privileges. In order to conduct Registration transactions, there must be a regular AMHA membership on all Registration paperwork. Replacement cards are $5 each upon request. Applicant agrees to abide by all the Rules, Regulations and decisions of the AMHA, its Officers and Directors or its appointees. Questions? Email - info@amha.org. There is an additional fee of $5.00 If Youth Membership is purchased at a local Show Youth Information: Name: _______________________________________________________________ First Middle Initial Last ___ Male ___ Female Age as of January 1 this year: ______ Birthday (mm/dd/yy): _____________ Street Address: ________________________________________________________ City: __________________ State: ____ Zip: _________ Country: _______________ Telephone: ________________________ Email: ______________________________ Parent’s Name(s), (First/Last): ____________________________________________ Name of individual(s) paying for membership if other than parent or youth: Individuals Name (First/Last) _____________________________________________ AMHyA Membership is $10.00 (or $15 if purchased at a local show)  Check or Money Order Enclosed (Make checks payable to AMHA) Non-sufficient funds checks will be assessed a $25 charge. To pay with CC please complete the following Name as it appears on card: ____________________________________________________________ Card #: ________ _________ _________ ________ Exp. Date: _________________ CVV: _____ Signature: __________________________________________________________________________ Would you be interested in donating to the AMHyA Youth Scholarship Fund at this time? (Scholarship fund supports AMHyA members in their effort to obtain a higher education)  $10  $15  $25  Other Amount: ___________ Do Not Send Cash in the Mail. PLEASE RETURN TO: AMHyA, 5601 S. INTERSTATE 35W, ALVARADO, TX 76009