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Northwest Paso Fino Horse Association
Nov. 1, 2009 thru Oct. 31, 2010

Mail-In Registration

Name:

Address:

City

State

Zip

Phone:

Fax:

Cell:

Email:

New Member?

Renewal?

(please check if applicable)______
NO, I cannot receive the electronic bimonthly newsletter! Please send me a copy in the mail.

We look forward to your membership and hope you will enjoy our events this year. You will receive a Membership Card, which will contain your name, address, and expiration date.

Annual membership is from November 1^st to October 31^st each year.
Please check appropriate box and mail corresponding payment to address below. Thank you.

_____ 1-Year Individual Membership . . . . . . . . . . . . . . . . . $35.00

_____ 3-Year Individual Membership . . . . . . . . . . . . . . . . . $90.00

_____ 1-Year Family Membership . . . . . . . . . . . . . . . . . . . . $55.00

_____ 3-Year Family Membership . . . . . . . . . . . . . . . . . . . . $150.00

_____ 1-Year Youth Membership . . . . . . . . . . . . . . . . . . . . $15.00 (ages 17 & under)

Please list names & date of birth of all youth members (including those in family memberships):

1. Name:_____________________________________________ DOB:____________________

2. Name:_____________________________________________ DOB: ____________________

3. Name:_____________________________________________ DOB: ____________________

4. Name: _____________________________________________DOB: ___________________

We have three (3) dedicated funds and if you would like to make an additional to any of these funds, you can include the amount with your dues. The funds are:

Youth fund: _____________ Newsletter Fund: ____________ Pointed Show Fund:____________

Or, you could make a donation to the General Fund:____________________

Please make checks to: Northwest Paso Fino Horse Association (NWPFHA) and mail to:

Judy Tolboe
NWPFHA Treasurer
22405 Skyview Ln
Bend, OR 97702

LIABILITY RELEASE: Must be signed, each year, by all members age 18 years and older.

I assume all liability from any causes whatsoever in connection with Northwest Paso Fino Horse Association, hereinafter called "this nonprofit organization" and I release this nonprofit organization and its directors, officers, employees, agents, and volunteers from all liability from any cause whatsoever in connection with this nonprofit organization.

Signature: ________________________________________________________

Date: _______________________

Signature: ________________________________________________________

Date: _______________________

Thank You for Your Membership!