Membership Form

Membership Form
Contact Information

"*" Indicates required field
Name*

First NameLast Name
Phone Number*
Email*
Month and Year of Birth*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Method of Contact

Phone CallEmailTextMail
Membership Details

Membership rules can be found on the OPHC website under membership tab at https://oregonpainthorseclub.com
APHA Number
(APHA membership is not required for OPHC membership)
Membership type: (Multiple selections allowed for family memberships)*

First time youth member - FreeFirst time member Adult - FreeYouth Member $25Single Adult Member $30Family (Only applies to parents and youth) $50Business $50
Sponsorship: OPHC greatly appreciates any level of sponsorship. Sponsorship dollars are used towards our annual spring show, youth scholarship fund and community educational events.

$15$25$50$75$100$150
Total
Family Members
Please list family members on your family plan and their APHA ID, Date of Birth and Division (ie Novice Youth)
A little more about your horse
Please list horse(s) name and age
Include all horses you or your family member(s) will be showing.
Division(s) you will compete in
Form can be submitted online and payment made with PayPal.

If you prefer to pay by check, make the check out to OPHC.

Mail to: Jamie Bansen

3695 SE Lafayette Hwy

Dayton, OR 97114

Questions? Contact Jamie 971-237-4164
My Products
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First time youth member
$ Free Quantity



First time member Adult
$ Free Quantity



Youth member
$25.00 Quantity



Single adult member
$30.00 Quantity



Family
$50.00 Quantity



Business
$50.00 Quantity



Total

$0.00
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

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