Balkan Saddle Club Membership Form 2011
DUE BY April 7, 2011
ALL MEMBERSHIPS MUST BE RECEIVED BY MAIL, AT PLAYDAYS OR MEETINGS, NO EXCEPTIONS!
Family $25.00 Single $15.00
PLEASE PRINT CLEARLY
Parent or Gaurdian: Single member:
Name:________________________________________ DOB:____________
Address:__________________________________________________________
City:_______________________________ State:_____________ Zip:________
E-Mail____________________@________________ Phone:_____ _____ ______
*Please check here if your E-mail has changed _______
*Please check here if your Address has changed______
HOW MANY YEARS HAVE YOU BEEN A MEMBER? _______
NEW MEMBER? (circle one) Y N
Family Members:
Name:_______________________________________ DOB:___________
Name:_______________________________________ DOB:___________
Name:_______________________________________ DOB:___________
Name:_______________________________________ DOB:___________
Name:_______________________________________ DOB:___________
DOB is required for WSCA
Remember a copy of a Negative Coggins Test is required to show.
The Coggins test must be dated within one year of the show date.
Send to:
Melissa Laitala
5763 Baich Rd
Chisholm, MN 55719