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Member(s)
Name(s):
Minor Children's Names & Birth Dates:
Address:
City:
Prov:
Postal
Code:
Telephone:
Fax:
E-mail: (Home or Work)
Submission
of the above information will be kept strictly confidential in CQHA's
database, unless you specifically request otherwise as follows:
I
also wish to receive communications and information direct from corporate
sponsors or partners of CQHA ____ (check)
I
also wish to receive communications and information direct from Equine-Hippique
Canada ____ (check)
I
also wish to receive communications and information direct from corporate
sponsors or partners of Equine-Hippique Canada ____ (check)
Membership
Fees paid for calendar year 201__ (please
check one of the following):
________"single"
membership (one adult, or one adult single
parent with 1 minor child 18 years & under, as of January 1 each year)
= 1 vote in CQHA - Fee payable = $10.00/year
________"family"
membership (two adults, and all minor children
18 years & under as of January 1, each year) = 2 votes in CQHA = $15.00/year
Please make cheque
payable to: CQHA and mail with this form to:
CQHA, c/o Box 1122, Carberry, MB R0K 0H0 |
