Rider/Owner Membership Application

Membership Type (includes processing fee)*

Individual Annual Membership

$46.35

Farm/Family Annual Membership

$61.80

Individual Life Membership

$360.50

Farm/Family Life Membership

$515.00

Additional Member #1 Name*

First NameLast Name
Designation*
Date of birth*

MonthDayYear
Date
USEF Membership Number (if applicable)
Additional Member #2 Name

First NameLast Name
Designation
Date of birth

MonthDayYear
Date
USEF Membership Number (if applicable)
Additional Member #3 Name

First NameLast Name
Designation
Date of birth

MonthDayYear
Date
USEF Membership Number (if applicable)
Declaration:

Applicant hereby agrees to be bound by the Rules of the MTHJA now in effect or as subsequently adopted
Signature

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Date

MonthDayYear
Date
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