WQHA 2009 Membership Form

Name ________________________________Spouse______________________

Address____________________________City___________State____Zip_______

Telephone______________________email Address__________________________

Division Showing    Amateur______-- -OR-- Select________ Novice  Yes    No (circle one)

Amateur Name____________________________

Youth Name_____________________Age____  Novice   Yes   No   (circle one)

Youth Name_____________________Age____ Novice   Yes    No   (circle one)

Note:  Owner And Exhibitor must be members before points will count

Family membership             $35.00

Mail Dues to:

WQHA

c/o John Sedgwick

11253 Coonrod Road

Cheyenne, WY  82009