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:

Business/Club/Organization Additional Information Name: Website: Category: Options: Horse & Rider Services - Adoption / Boarding / Breeders / Camps / Carriage / Clinics / Clinicians / Dentistry / Education / Farrier / Horsemanship / Humane Welfares / Lessons / Rescue / Showing / Training / Transportation / Therapeutic / Veterinarian. Organizations & Clubs - Driving / Horse Organization / Horse Club / Social / Trail / Youth (4H, Pony Club, College teams, etc.). Trail Services - Lodging / Camping. Business Services - Insurance / Legal / Marketing / Promotional / Publications. Sales & Products - Barns/Buildings / Feed/Supplements / Tack / Trailer/Truck / Shop & Apparel Description (short):

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)

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:
NYSHC Membership/SB, PO Box 236, Marlboro NY 12542

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