Membership Form ...Print Only

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

All fields required which apply!
Name: First Last Email: Address: City: State: Zip Code: Phone:

Chapter: General Cattaraugus/Chautauqua Eastern Hudson Valley Orange Sullivan Ulster Western

Membership Type: Individual With Insurance ($66) Individual No Insurance ($40) Family With Insurance ($92) Family No Insurance ($60) Life Membership With First Year Insurance ($556) Life Member Insurance Only ($31) Youth No Insurance ($15) Commercial/Business/Association/Club/Farm ($80)

Business/Club/Organization Additional Information
Name: Website: Category: Horse & Rider Services - Adoption / Boarding / Breeders / Camps / Carriage / Clinics / Clinicians / Dentistry / Education / Farrier / Horsemanship / Humane Welfares / Lessons / Rescue / Showing / Training / Transportation / Therapeutic / Veterinarian / Driving Club / Horse Organization / Horse Club / Social / Trail / Youth Club, College Team / Trail Services / Lodging / Camping / Insurance / Legal / Marketing / Promotional / Publications / Sales & Products / Feed/Supplements / Tack / Trailer/Truck / Shop & Apparel
Description (short):

OFFICIAL BUSINESS ONLY Date Received: Check Number: Amount Paid:

NYSHC Newsletter via: E-Mail (No Extra Cost) Postal Mail (Add $10)

Referring Member/Number:

*Make checks payable to NYSHC mail to:
Amy Alexander
7719 Old Lower East Hill Road
Colden NY 14033

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