MEMBERSHIP APPLICATION FORM

 Print this form to be filled out and mailed in with membership fee

NAME: ________________________________________Spouse’s Name:_________

Name of Stable or Farm: ________________________________________________

Address: _____________________________________________________________

City:______________________________________State__________Zip__________

Telephone: (___)__________________Fax:(___)_____________________________

Work: (___)____________Email:__________________________________________

Please check all that apply:

Breeder__  Trainer __  Stallion Service __ Interested __  Exhibitor __  Youth __

Performance Horse __ Pleasure Horse __ TW/Spotted __  Spotted Saddle Horse __

Racking Horse __ Driving __ Trail Ride __  Futurity __ Versatility __ Other __

Family Membership __ Individual Membership __ Youth Membership __

Do you show your horse? ___

Optional:

Birthday: _________________________ Spouse’s Birthday:____________________

Children’s Names: _____________________________________________________

Children’s Birthday(s):__________________________________________________

Other Dates of Importance:_______________________Anniversary:_____________

What type of work do you do?:_____________________Spouse:_________________

Do you presently own Tennessee Walkers?:________ How many?:________________

What Kind?:___________________________________________________________

How can we help you?:___________________________________________________

Family & Adult Individual Memberships: Complete & send with your check.  $30.00, payable to IWHA, Mail to:  Shirley Miller, 15687 Lake Carlinville Rd. Carlinville, IL 62626  [217-854-2162]

Youth Memberships: Complete & send your check. $5.00 payable to IWHA. Mail to:   Helen Clemens 220005 Boehle Ln. P.O. Box 502, Chillicothe, IL 61523  309-274-6870