SRCHA Membership Form

2018 Membership Form

Send to SRCHA c/o Gay Lenz, 11587 Hunt Lane, Guthrie, OK 73044 Phone (405) 818-7556, FAX (405) 730-8050 email: entry@srcha.org Make Checks payable to SRCHA Credit Cards Accepted (Master Card and Visa) Or Just press submit.
Name

First Name Last Name
E-mail
Phone Number:

- Area Code Phone Number

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Type of Membership *

Individual $35 Family $60 (List names Below) Youth $10 Free for 1st year member One Time Event $10.00 (Only good for one event) List event in the notes section.
Enter event here if you are doing One Time Fee
Family Name
Family Name
Family Name
Family Name
Yes! I would like to support SRCHA Please put my sponsorship towards:
Sponsorship Amount
BECAUSE OF YOU!
Payment *

Show Tab Check Cash Credit Card Free for first year member

If using Credit Card Choose one of these options.

Indivudual Membership $ 35.00

Family Membership $ 60.00

Youth Membership $ 10.00

One Time Event $ 10.00

SRCHA Sponsorship $ 100.00

Quantity

Total $ 0.00

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

Should be Empty: