Nevada Equine Council MEMBERSHIP/RENEWAL FORM

NEVADA EQUINE COUNCIL
MEMBERSHIP/RENEWAL FORM
All prospective members of NVEC are required to complete this registration form. Indicate any changes; Membership is for NEW MEMBERSHIPRENEWALChanges for directory? one year except Lifetime Memberships.
SECTION I: MEMBER CONTACT INFORMATION
BUSINESS NAME
for BUSINESS memberships
NAME*
ADDRESS I*
TOWN/CITY*

ADDRESS 2

Street Address Line 2

TOWNCITYState / Province

Postal / Zip Code
ZIP CODE*
MAIN TELEPHONE*
HOME TELEPHONE
WORK TELEPHONE
MOBILE PHONE
JOB TITLE
PRIMARY EMAIL*
example@example.com
SECONDARY EMAIL
example@example.com
Please indicate which e-mail and phone number you would like listed in the directory*
SECTION 2: MEMBERSHIP TYPE (All memberships renew ANUALLY except Lifetime)

Please indicate the membership type you are selecting by typing your name in the corresponding field
INDIVIDUAL/LIFETIME - $25 Annual/ $400 Lifetime
Individuals 18 and older, please specify "individual" or "Lifetime"
STUDENT - $15
Open to individual youth under 18 the year of membership
FAMILY - $40
All families defined as 2 adults and any children under 18 permanently residing in the same home. Please list all family member names and DOB for children under 18
SMALL BUSINESS & ASSOCIATIONS - $150
For-profit businesses with less than 15 employees and for-profit and non-profit associations actively involved in equine related activities.
LARGE BUSINESSES - $300
For-profit wholesale or retail businesses, professionals, etc with 15-40 employees
CORPORATE BUSINESSES - $500
For-profit wholesale or retail businesses, professionals, etc with 41 or more employees
SECTION 3: MEMBER INFORMATION
OCCUPATION /JOB TITLE:
Do you subscribe to the NVEC mailing list? YES or NO (provide e-mail address if not listed)*
Would you like to be listed in the NVEC directory? YES or NO *
Would you be willing to serve on the board or a committee? YES or NO*
Is there a specific issue you would like to help with or committee you would like to serve on?
Permission to use photographic images: Photographs of NVEC members may be used in various NVEC communications incl. the newsletter and website. Please indicate your permission for use:
NVEC has my permission to use and identify photographs of me
NVEC does not have permission to use and identify photographs of me
NVEC must contact me before using any identified photographs of me in NVEC communications.
PLEASE INDICATE YOUR PAYMENT METHOD - (Card-via website, Zelle, Check-see instructions below)*
Signature*

Clear
Date

MonthDayYear
Date
To Pay by check:

Make check payable to "Nevada Equine Council" and mail to:

Nevada Equine Council, PO Box 1184, Silver Springs, NV 89429

Please include a printed copy of your application.
Should be Empty:

NEVADA EQUINE COUNCIL

MEMBERSHIP/RENEWAL FORM

SECTION I: MEMBER CONTACT INFORMATION

SECTION 2: MEMBERSHIP TYPE (All memberships renew ANUALLY except Lifetime)

SECTION 3: MEMBER INFORMATION