Printable Membership Application
Please enclose proper amount with application.
For rules regarding lifetime membership, or any questions regarding the application,
contact the secretary of the association, or write to the address above.
** All memberships include Percheron News subscription**
  Membership dues are due at time of application for the first year,
or part of year, and then on November 1st for the upcoming year.

Choose Desired Membership:

[   ]  Lifetime Membership: $500.00 U.S.            [   ]  Regular Membership:  $40.00 U.S.
                          You pay no annual dues.                                          $10, one time membership fee, plus $30 annual due.

[   ]  3-Year Membership: $85.00 U.S.

$10, one time membership fee, plus 3 years $25 annual dues.
 Please issue Certificate in the name(s) of :                 Single Membership          Joint Membership

  Name(s):   ________________________________           __________________________________
 
  Address:   ________________________________________________________________________
 
  City :  ___________________________  State : ________________  Zip+4 : ________+_______ 
 
  Phone: (______)    _______---____________    Email Address: __________________________

    I, (We) hereby subscribe for membership in the Percheron Horse Association of America. I agree to
  abide by all of the  provisions of the by-laws and regulations of the association which are now in force
  and hereafter enacted.                                                         Payable in U.S. Dollars Only.
        This application is a legal document, and must be signed by the person(s) applying for membership.

  Signed:  X__________________________________   X___________________________________ 

              Note:  Joint memberships are limited to two persons, and must be signed by both parties.

For Credit Card Payment Only!

[  ] Visa   [  ] MasterCard    Number ______  ______  ______  ______   Expiration Date ________

Name(s) on Card __________________________    Signature ______________________________

***Prices quoted above are for Cash, Check or Money Order.
 A 10%, min. $5, service charge will apply to all Credit Card transactions.***