CAHSA Membership Enrollment Form

1
CAHSA Membership Enrollment FormBecome a member of Central Arkansas Horse Show Association
2
MEMBER VOTING PRIVILEGES* This field is required.Any person age 18 and over who is a paid member of good standing shall have one (1) vote at Membership Meetings.
Agree to Member Voting PrivilegesDO NOT agree to Member Voting Privileges
3
LIABILITY DISCLAIMER* This field is required.CAHSA will not be responsible for any accidents or damages that may occur to any person, animal, property, or any damage to any vehicles on the show grounds. Exhibitors and/or spectators shall hold management, Board Members, and/or property owners harmless and indemnify against any legal proceedings that may arise from such accidents.
Agree to Liability DisclaimerDO NOT agree to Liability Disclaimer
4
MEMBERSHIP APPROVAL* This field is required.All memberships are subject to CAHSA approval. If, at any time, a member displays unsportsmanlike conduct on site, off site, or on social media outlets, the CAHSA Board reserves the right to expel the member, regardless of point standings, at the CAHSA Board's discretion without reimbursement of dues paid.
Agree to Membership ApprovalDO NOT agree to Membership Approval
5
Healthcare* This field is required.Is any person to be listed on this membership enrollment in the healthcare industry?
YESNO
6
Name of Healthcare employed individual
First Name
Last Name
7
HEALTHCARE INDIVIDUAL - Please complete the phone number of the member that is employed in the healthcare industry
Please enter a valid phone number.
8
MEMBERSHIP TYPE* This field is required.Individual Membership is restricted to those who are 18 years of age or older. Due to insurance regulations, all minors must be on a family membership with a parent or legal guardian listed on the family membership with the minor. Family Membership is defined as married persons or Grandparents and any unmarried children (under the age of 21) living in the same household. All members on a family membership must live in the same household.
Please Select
Please Select
INDIVIDUAL MEMBERSHIP - CANNOT BE A MINOR
FAMILY MEMBERSHIP
9
INDIVIDUAL MEMBERSHIP - MEMBER NAME* This field is required.List the member's full name
First Name
Last Name
10
INDIVIDUAL MEMBERSHIP - MEMBER'S DATE OF BIRTH* This field is required.Select the member's date of birth
Date
Month
Day
Year
11
INDIVIDUAL MEMBERSHIP - MEMBER'S PHONE NUMBER* This field is required.Complete the phone number to be used in connection with the membership
Please enter a valid phone number.
12
INDIVIDUAL MEMBERSHIP - MEMBER'S PHYSICAL ADDRESS* This field is required.Please complete the address to put on file for the membership
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
13
INDIVIDUAL MEMBERSHIP - MEMBER'S EMAIL ADDRESS* This field is required.Please complete the email address to be used in connection with the membership
example@example.com
14
INDIVIDUAL MEMBERSHIP - CONTACT PREFERENCE* This field is required.Which way do you prefer to be contacted?
Phone Call
Text Message
Email
15
INDIVIDUAL MEMBERSHIP - MEMBER'S AGE DIVISION* This field is required.Select Age Division of member #1 (even if this member will not be competing, please select the age division of member #1)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
16
FAMILY MEMBERSHIP - MEMBER #1 NAME* This field is required.List the member's full name (Parent / Legal Guardian name goes here)
First Name
Last Name
17
FAMILY MEMBERSHIP - MEMBER#1 DATE OF BIRTH* This field is required.Select the date of birth for member #1
Date
Month
Day
Year
18
FAMILY MEMBERSHIP - MEMBER #1 PHONE NUMBER* This field is required.Phone number for member #1 / phone # to be used in case of an emergency
Please enter a valid phone number.
19
FAMILY MEMBERSHIP - MEMBER#1 ADDRESS* This field is required.Please complete the address to put on file for the membership
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
20
FAMILY MEMBERSHIP - MEMBER #1 EMAIL ADDRESS* This field is required.Please complete the email address to be used in connection with the membership
example@example.com
21
FAMILY MEMBERSHIP - CONTACT PREFERENCE* This field is required.Which way do you prefer to be contacted?
Phone Call
Text Message
Email
22
FAMILY MEMBERSHIP - MEMBER #1 AGE DIVISION* This field is required.Select Age Division of member #1 (even if this member will not be competing, please select the age division of member #1)
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
23
FAMILY MEMBERSHIP - MEMBER #2 NAME* This field is required.List the member #2's full name
First Name
Last Name
24
FAMILY MEMBERSHIP - MEMBER#2 DATE OF BIRTH* This field is required.Select the date of birth for member #2
Date
Month
Day
Year
25
FAMILY MEMBERSHIP - MEMBER #2 AGE DIVISION* This field is required.Select Age Division of member #2
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
26
NEED TO ADD A 3RD MEMBER TO MEMBERSHIP?* This field is required.If only 2 members will be listed in this family membership, please select no and proceed to the next section of the membership form.
YESNO
27
FAMILY MEMBERSHIP - MEMBER #3 NAME* This field is required.List the member #3's full name
First Name
Last Name
28
FAMILY MEMBERSHIP - MEMBER#3 DATE OF BIRTH* This field is required.Select the date of birth for member #3
Date
Month
Day
Year
29
FAMILY MEMBERSHIP - MEMBER #3 AGE DIVISION* This field is required.Select Age Division of member #3
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
30
NEED TO ADD 4TH MEMBER TO THIS MEMBERSHIP?* This field is required.If only 3 members will be listed in this family membership, please select no and proceed to the next section of the membership form.
YESNO
31
FAMILY MEMBERSHIP - MEMBER #4 NAME* This field is required.List the member #4's full name
First Name
Last Name
32
FAMILY MEMBERSHIP - MEMBER#4 DATE OF BIRTH* This field is required.Select the date of birth for member #4
Date
Month
Day
Year
33
FAMILY MEMBERSHIP - MEMBER #4 AGE DIVISION* This field is required.Select Age Division of member #4
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
34
NEED TO ADD 5TH MEMBER TO THIS MEMBERSHIP?* This field is required.If only 4 members will be listed in this family membership, please select no and proceed to the next section of the membership form.
YESNO
35
FAMILY MEMBERSHIP - MEMBER #5 NAME* This field is required.List the member #5's full name
First Name
Last Name
36
FAMILY MEMBERSHIP - MEMBER#5 DATE OF BIRTH* This field is required.Select the date of birth for member #5
Date
Month
Day
Year
37
FAMILY MEMBERSHIP - MEMBER #5 AGE DIVISION* This field is required.Select Age Division of member #5
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
38
NEED TO ADD 6TH MEMBER TO THIS MEMBERSHIP?* This field is required.If only 5 members will be listed in this family membership, please select no and proceed to the next section of the membership form.
YESNO
39
FAMILY MEMBERSHIP - MEMBER #6 NAME* This field is required.List the member #6's full name
First Name
Last Name
40
FAMILY MEMBERSHIP - MEMBER#6 DATE OF BIRTH* This field is required.Select the date of birth for member #6
Date
Month
Day
Year
41
FAMILY MEMBERSHIP - MEMBER #6 AGE DIVISION* This field is required.Select Age Division of member #6
PeeWee (10 yrs of age and under - only classes for 10 and under and Showmanship will count towards high point standings)
Buckaroo (13 yrs and under - 10 and under classes WILL NOT count for high point standings)
Junior (14 yrs to 18 yrs)
Senior (19 yrs and over)
42
ACKNOWLEDGMENT* This field is required.This membership enrollment requires you to confirm that all of the previously entered information is true and accurate to the best of your knowledge. Do you agree to the submission of this membership enrollment form?
YESNO
43
PERSON SUBMITTING ENROLLMENT FORM* This field is required.Please include the full name of the individual that is completing this membership enrollment form
Full Name: First Last
44
We are sorry, your membership enrollment could not be submitted at this time.
45
MEMBERSHIP FEES / FORM OF PAYMENT* This field is required.Individual Membership Fee: $40 Family Membership Fee: $50 MEMBERSHIP IS NOT CONSIDERED SUBMITTED UNTIL PAYMENT OF MEMBERSHIP FEE HAS BEEN RECEIVED BY CAHSA Please select the form of payment that you choose to pay the membership fee due
Please Select
Please Select
Cash
Check
Square / Electronic Payment Option
46
Thank you so much for your participation and support of Central Arkansas Horse Show Association!

We look forward to seeing you at the shows this season! To complete the membership enrollment process, please click submit below and your completed information will be sent to the Board Members of CAHSA for processing.
Should be Empty: