New York State Horse Council ...NYSCH
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2017 MEMBERSHIP FORM

New York State Horse Council, Inc
Memberships are for the calendar year Jan. 1-Dec. 31

Please complete all fields which apply.

Please check one:
Renewal -- ID#
New Membership

I wish to receive the NYSHC Newsletter via: E-Mail Postal Mail

Name of Member # 1:

Family Members with children names & age: (*If Family Membership)

Business/Club/Farm/Organization:

Mailing Address:

City: State: Zip Code: County:

Phone:
Email (Required for Online Submission):

Website:

Volunteer Availability/Interests:

Number of Equine You Own?

Please check the NYSHC Chapter you wish to join. A portion of your dues is transferred to that chapter for their activities.

Age of Primary Member for Vintage Equestrian Program Records

Membership Type

Individual with insurance $55.00 (One adult 18+)

Family with insurance $75.00 (Two adults & children up to age 18)

Lifetime with insurance 1st year only $500.00 (individual only)

Lifetime subsequent years with insurance $20.00 (individual only)

Individual without insurance $35.00 (One adult 18+)

Family without insurance $55.00 (Two adults & children up to age 18)

Youth without insurance $10.00 (up to age 20) Please note: Effective Jan. 1, 2017 age change from 20 to 18 Youth Parent Signature Required here: _______________Youth Birthdate: _________In addition-must send form via postal mail with signature

Organization/Club/Business/Farm no insurance, includes web link on our NYSHC website http://www.nyshc.org/member_organizations.php and NYSHC Member Businesses listed in the NYSHC Quarterly Newsletter $75.00

Method of Payment:

If you are not comfortable with Paypal or run into issues,
please write a check and send with the printed Membership Form.

Please make check payable to New York State Horse Council.
Please write 2017 Membership on the check.
There will be a $25 charge for returned check.
Send this form along with check to:
Paula Pratt
NYSHC Membership Chair
3555 Stetson Road
Bloomfield, NY 14469
Questions: Call Paula Pratt @ (585) 657-4550 or membership@nyshc.org

*For inquiries regarding Insurance through Equisure/Association Resource Group, please contact Missy Whittington at (716) 655-2045 or via e-mail Missy.Whittington@NYSHC.org.

*For inquiries or advertisement regarding the NYSHC Quarterly Newsletter, please contact Mary Szarek at (716) 837-3761 or Email: info@wnyHorse.info.

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