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2008 MEMBERSHIP APPLICATION 2007 |
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□ Single (1 vote) $40.00 Complete section 1 below □ Family (2 vote) $50.00 Complete section 1 & 2 below □ Youth Only $5.00 Complete section 1 □ Renewal 2008 □ New
Member □ Canadian member please add $25.00 for first-class mailing fee |
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SECTION 1 |
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□ Please mark
if address or phone number has changed.
A portion of the following information will be listed in the directory. Name _________________________________________ Occupation ________________________________ Ranch Name
________________________________ Address ______________________________________ City _______________________________________ State ________________ Zip ____________________ Home Phone (___)_____________Day Phone
(___)_____________Email _____________________________ |
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Please mark all that apply: □ OWNER □ TRAINER (A trainer’s list will be published in the
directory |
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Do you have accident and/or medical
insurance ______ Yes ______ No Do you have personal and/or liability
insurance to insure your personal and/or horse activates_______ Yes ______ No |
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SECTION 2: FAMILY MEMBERSHIP |
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Spouse____________________________________________Occupation_____________________________________ Children & Dates of Birth___________________________________________________________________________ _________________________________________________________________________________________________ Company
___________________________________________________ Phone (___)__________________________ |
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SECTION 3: ASSOCIATE MEMBER ONLY |
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Address
__________________________________________________________________________________________ Category: □ Auto Dealer-Truck
Dealer □ Fuel □
Insurance □ Motel -Hotel □ Feed-Tack-Farm Store & Product □ Horseshoer □ Real Estate □ RV-Travel
Trailer-Camper □ Stallion Station-Breeding Farm □ Horse
Trailer □ Saddle Maker □ Veterinary □ Other
________________________________________ |
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SEND DUES PAYMENT TO: OCHA
42303 Rodgers Mountain Loop, Scio OR 97374 |