VQHA Membership Application

VQHA Membership Application
Memberships run from January 1 to December 31 of current year. If you do not join by January 1, memberships run from postmark to December 31 of current year.

** Reminder**

Horses must be nominated yearly in order to be eligible for year-end awards.
Click to edit*

RenewalNew Member
Full Name:*
MUST include First and Last Name.
Birth Date

MonthDayYear
AQHA Number*
Expires:*
E-mail:*
Select One:*

OpenAmateurNovice AmateurOpen Show ProgramYouthNovice Youth
Select Amateur Members Only (For combined classes, choose only ONE of the following)

Count my points toward AmateurCount my points toward Select Amateur
Phone:*
Address:*
City:*
State:*
Zip Code:*
Back No. Request:
Spouse Name
(if family membership)
Spouse AQHA ID:
Youth Name:
Birth Date

MonthDayYear
AQHA Number
Back No. Request:
Please Select One:

YouthNovice Youth
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Youth Name:
Birth Date

MonthDayYear
AQHA Number:
Back No. Request:
Please Select One

YouthNovice Youth
...
Youth Name:
Birth Date

MonthDayYear
AQHA Number:
Back No. Request:
Please Select One:

YouthNovice Youth
Horse Nomination Information
Horse #1 Registered Name
Horse #1 AQHA Reg. Number
Horse #1 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #2 Registered Name
Horse #2 AQHA Reg. Number
Horse #2 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #3 Registered Name
Horse #3 AQHA Reg. Number
Horse #3 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #4 Registered Name
Horse #4 AQHA Reg. Number
Horse #4 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #5 Registered Name
Horse #5 AQHA Reg. Number
Horse #5 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #6 Registered Name
Horse #6 AQHA Reg. Number
Horse #6 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #7 Registered Name
Horse #7 AQHA Reg. Number
Horse #7 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #8 Registered Name
Horse #8 AQHA Reg. Number
Horse #8 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #9 Registered Name
Horse #9 AQHA Reg. Number
Horse #9 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
...
Horse #10 Registered Name
Horse #10 AQHA Reg. Number
Horse #10 Registered Owner Name
Owner name as shown on AQHA Registration
Year Foaled
Sex

StallionMareGelding
Please select appropriate options:
NOTE:

For Youth and Amateur Memberships you MUST pay the Individual Membership Fee in addition to the Youth or Amateur Membership fee for your points to count towards year-end awards.

A Family Membership does not include Youth or Amateur Membership fees.
...
(will total as you select)

VQHA Membership*

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please review the information above carefully before you click submit.

Your credit card information will be processed through Stripe and is encrypted before being sent over the Internet.

If you have membership questions, please contact Corinne Balsis.
Just so we know you're a person and not a computer*
E-mail
example@example.com
Should be Empty:

VQHA Membership Application

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Horse Nomination Information

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Please select appropriate options:

NOTE:

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