Bristol County Horsemen's Association

MEMBERSHIP APPLICATION

NAME: _____________________________________________________________________

PHONE: ____________________________________________________________________

ADDRESS: __________________________________________________________________

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EMAIL: ____________________________________________________________________

SINGLE ANNUAL YOUTH MEMBERSHIP ($8.00) ____

SINGLE ANNUAL MEMBERSHIP ($15.00) ____

FAMILY ANNUAL MEMBERSHIP (20.00) ____

LIST OTHER FAMILY MEMBERS COVERED BY THIS APPLICATION (IF APPLICABLE)

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PLEASE MAKE  CHECK OR MONEY ORDER PAYABLE TO BCHA AND SEND TO

BCHA c/o

Elizabeth Norton, Treasurer

69 Middleboro Avenue

Taunton, MA  02780