Appalachian Appaloosa
            Association

        
              MEMBERSHIP
              APPLICATION
                   
 2008

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                                             APPALACHIAN  APPALOOSA ASSOCIATION
    
                                                         3759 Klondike Road
                                                                      Delaware, Ohio43015
                                                                      


                                                     2008 MEMBERSHIP APPLICATION

             
             

TODAY'S DATE:___________________

NAME:
    ______________________________________________________________
STREET  ADDRESS
:  ______________________________________________________
CITY__________________________  STATE__________     ZIP___________
HOME PHONE:_________________________      CELL PHONE:__________________________   
E-MAIL__________________________________________________________________________     

( )  Individual  Membership, adult  - $15.00             
( )  Individual Membership, youth  -  $10.00
( )  Family Membership  -  $20.00

ApHC MEMBERSHIP # _____________________

PLEASE LIST FAMILY MEMBERS BELOW:

  Name:                                                                          ApHC #:            Age as of Jan. 1st:

____________________________________________   ______________   ___________________

____________________________________________   ______________   ___________________

____________________________________________   ______________   ___________________


                                         _________________________________________
                                              Signature of parent/gardian for individual members
                                                             under the age of eighteen years

                                 Please check the membership you prefer and mail check,
                     payable to Appalachian Appaloosa Association, to the above address. 

                                  For questions regarding membership please contact: 

                                       Membership, Kelly Thompson (937)289-3371 or
                                             President, Greg Miller (937)981-4570

                                Please send all membership applications to the Treasurer
                                                               Brian Amerine
                                                           3759 Klondike Road
                                                           Delaware, OH  43015