MEMBERSHIP FORM

ARIZONA PAINT HORSE CLUB

2024 Membership Form
Submission Date

MonthDayYear
Date
NewRenewal
Please select the type of membership:

Youth ($20 - 1 year)Youth ($50 - 3 years)Adult ($35 - 1 year)Adult ($80 - 3 years)Married ($45 – 1 year)Married ($100 – 3 years)Ranch/Business ($45 – 1 year)Ranch/Business ($100 – 3 years)
(Membership Voting: Adult gets 1 vote, Married gets 2 votes, Ranch/Business gets 2 votes)
Member Name (1)*

First NameLast Name
Member Name (2)

First NameLast Name
Ranch/Business Name
If Married or Ranch/Business, please add up to two exhibitors below for point calculations: Last Name First Name Last Name p>
Exhibitor 1 Name:

First NameLast Name
Exhibitor 2 Name:

First NameLast Name
Youth Date of Birth

MonthDayYear
Parent/Guardian

First NameLast Name
Membership Fee
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member (1) Phone
Member (1) Email*
Member (2) Phone
Member (2) Email
APHA Member Number:
SUBMIT ONLINE BELOW, OR PRINT and MAIL COMPLETED FORM AND CHECK PAYMENT TO:

Jennifer Hungate
4726 S. Calderon Cir., Mesa, AZ 85212

Email – arizonaphc@gmail.com
Payment Method*

Credit Card (add 4%)Check or Money Order

Charge my credit card for the following Membership (select one):

Youth - 1 Year$20.00

Youth - 3 Years$50.00

Adult - 1 Year$35.00

Adult - 3 Years$80.00

Married - 1 Year$45.00

Married - 3 Years$100.00

Ranch/Business - 1 Year$45.00

Ranch/Business - 3 Years$100.00

Subtotal $0.00Tax $0.00Total $0.00