|
|
 |
Q. H. R. A. I. M E M B E R S H I P A P P L I C A T I O N
YEAR____________ (JAN. 1 THRU DEC. 31)
NAME_________________________________________
ADDRESS______________________________________
CITY_________________________________________
ST_____ ZIPCODE________________
TELEPHONE: (DAYS)____________________(NIGHTS)______________
FAX___________________e-mail_______________________________
Are you: OWNER___ BREEDER___TRAINER___JOCKEY___
OTHER AFFILIATION WITH HORSE INDUSTRY?_____________________
HOW MANY HORSES DO YOU OWN________________
Please complete this form and mail it and your check or money
order for $25 (U.S. funds) to:
Q. H. R. A. I. Inc.
c/o TERESA GROSS
P.O. BOX 307
LEBANON, IN 46052
Office Use: Postmark________ Computer_______ Card_______
Check No.________Cash______Other_______
|
|
|
|
|
|
|
|
|
|
|
