2010-11 CNYHC MEMBERSHIP APPLICATION

Please complete the following information and return with your check payable to CNYHC to

CNYHC c/o M. Talutis
5783 McFarlane Rd.
Cincinnatus, NY 13040

This is very important information for determining speakers, topics and will also aid in getting articles of interest into the newsletter.

New Membership: (circle)
Jan-Mar 31 Individual Membership $10.00 (membership is for year ending June 30, 2010 1/2year membership)
Family Membership $12.50 (membership is for year ending June 30, 2010, 1/2year membership)

Apr 1-Jun30 Individual Membership $20.00 (membership is for full year ending June 30, 2011)
Family Membership $25.00 (membership is for full year ending June 30, 2011)

Jun 30 -Dec 31 Individual Membership $20.00 (membership is for full year ending June 30, 2011)
Family Membership $25.00 (membership is for full year ending June 30, 2011)

Renewal of Membership: (circle) Individual: $20.00/ Family: $25.00/yr (membership is for full year ending June 30, 2011)

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Name____________________________________ Telephone#_____________________________
Street__________________________________ County_________________
City/Town_________________________ Zip_____________ E-mail Address________________________________
Farm Name_____________________________ Occupation_____________________________
# of horses______ Breed________________________ Primary horse interest___________________
Other horse interests________________________________________
# of years involved with horses____
Do you have a horse related business or offer horse related services? _______If so, tell us about it____________________________________________________________________________________
_____________________________________________________________________________________
Would you like it added to our website business directory? __________If so, please forward your business card in electronic format to wakula1@juno.com

Any personal horse related history you would like to share:___________________________________ ______________________________________________________________________________________
I would like to know more about:_________________________________________________________
I would volunteer for (circle choices) Membership Trail Trial Poker Run Hunter Pace Horse Fair Tack Sale Publicity Trails Newsletter other________________
Your Ideas__________________________________________

Would you like to receive club information via e-mail? _________

Date Pd________ Amt. Pd________

Name of CNYHC member who referred you: _________________________________