Central Carolina Western Horseman Association

Application For Membership

2008 Season
Please Print!!
Name: _______________________________________________________________________
Mailing Address: ______________________________________________________________
Street Apt/Unit #
__________________________________________________________________
City State Zip                                                                                                      __    
County of Residence:________________________________________________
Telephone (Home) _____________________________ (Work)_________________________
(Include Area Code)

Please provide us with your email address in case we need to contact you)
________________________________ (format: xxx@abc.com)

Please list names, ages, and birthdates of all persons included on the membership (children must be 18 and under)

Name

Age

Birthdate

Name

Age

Birthdate

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Please list any information about yourself or suggestions for the Association.

Type of Membership: (please check one) Family____($30.00) Individual____($20.00)

Signed: ____________________________________________ Date: _____________________
Member
Return form to Secretary Membership paid by:

Michelle McGhee Cash_____Check_____
1490 Gordon Moore Rd. Secretary initials: ________
Franklinton, NC  27525 Treasurer initials ________
Telephone:
(919) 494-5536
Email:  Michellemeg@earthlink.net

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