MEMBERSHIP FORM

ARIZONA PAINT HORSE CLUB

2023 Membership Form
Submission Date

MonthDayYear
Date
NewRenewal
Please select the type of membership:

Youth ($20 - 1 year)Youth ($50 - 3 years)Adult ($35 - 1 year)Adult ($80 - 3 years)Husband/Wife ($45 – 1 year)Husband/Wife ($100 – 3 years)Ranch/Business ($45 – 1 year)Ranch/Business ($100 – 3 years)
(Membership Voting: Adult – 1 vote; Husband/Wife – 2 votes; Ranch/Business – 2 votes)
Business Name
Member Name (1)*

First NameLast Name
Member Name (2)

First NameLast Name
Youth Date of Birth

MonthDayYear
Parent/Guardian

First NameLast Name
Membership Fee
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Member (1) Phone
Member (1) Email*
Member (2) Phone
Member (2) Email
APHA Membership Number:
APHC Membership Directories include listing your name, address,
phone number and email address for our other members. If you do
NOT wish to have your information published, please check box to right:
Non-Published
SUBMIT ONLINE BELOW, OR PRINT/MAIL COMPLETED FORM AND PAYMENT TO:

Wendy Brown- 20701 N Scottsdale Rd Ste 107-608

Scottsdale AZ 85255
Email – MembershipAPHC@gmail.com
Payment Method*

Credit Card (add 4%)Check or Money Order

Charge my credit card for the following Membership (select one):

Youth - 1 Year$20.00

Youth - 3 Years$50.00

Adult - 1 Year$35.00

Adult - 3 Years$80.00

Husband/Wife - 1 Year$45.00

Husband/Wife - 3 Years$100.00

Ranch/Business - 1 Year$45.00

Ranch/Business - 3 Years$100.00

Subtotal $0.00Tax $0.00Total $0.00