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
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