LOUISIANA THOROUGHBRED BREEDERS ASSOCIATION

P. O. BOX 24650 NEW ORLEANS, LA 70184
PHONE: 504-947-4676 FAX: 504-943-2149

There shall be one class of membership. Any individual or legal entity is eligible for membership provided the member pays all fees and penalties. Voting privileges of members are accorded to any individual or legal entity and is registered as the breeder of at least 50% of an accredited Louisiana foal for the year in which the foal is registered and one year thereafter. Any individual or legal entity is eligible for membership and voting privileges provided the member pays all fees and penalties, if any, and is listed as currently owning not less than 100% of a stallion that is registered with the. Louisiana Thoroughbred Breeders Association and standing in the State of Louisiana. A legal entity shall be allowed to designate only one member with a right to vote and any member designated with a right to vote for a legal entity must sign the attestation on the back of the membership form for the legal entity. All members of the legal entity must be members of the LTBA. A member can only vote once per election be it as an individual member or as a selected member of a legal entity. All breeders to an accreditation must be members to receive the membership fee rate. An eligible person and/or entity must apply for membership, and be approved by a majority vote of the Board of Directors. Upon such approval and the Executive Director confirming to the Board that the current membership dues and/or penalties have been paid, membership shall be awarded. The dues shall be refunded if the application is not approved.

A W-9 form must be on file with the LTBA office for payment of any incentive awards. Individuals will use their social security number, and farm/business entities will use their Federal Identification Number.

The undersigned hereby acknowledges that the information provided herein is true and correct to the best of his (her) knowledge:

*Please list the names of foals you have bred in the last two years and/or stallions owned, percentage owned (you can use the mare’s name and foaling year), and their current domicile location (farm name & city) in Louisiana. This will enable the LTBA management to accurately determine voting rights. All foals are not needed.

I attest that I am a shareholder of the legal entity listed as a member on the previous page. As a member of the LTBA as well, declare that I will relinquish my vote as an individual member in order to vote as a member of the previously mentioned entity.

Department of the Treasury Internal Revenue Service

Go to www.irs.gov/FormW9 for instructions and the latest information.

Give form to the requester. Do not send to the IRS.

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number SSN However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number EIN If you do not have a number, see How to get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I amno longer subject to backup withholding; and

3. I am a U.S. citizen or other U.S. person (defined below); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Certification instructions.

You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholdingbecause you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.