Coachella Valley Horseman's
   Association

P.O. Box 10891, Palm Desert, CA 92255

MEMBERSHIP  FORM
You may print this form and then complete and mail it in with your check.


First Name_______________________  Last Name ______________________  

Street Address________________________________________

City_________________________________     State_______     Zip __________

Phone (_____) - _________________________    
Type of Membership: (please check one)

MY
   EQUESTRIAN  
INTERESTS

 [  ] English
 [  ] Western
 [  ] Hunter
 [  ] Trail Riding
 [  ] Playdays
 [  ] Other (specify)
 ______________

 ______________

    [  ]  Horse Show Members (horse shows only)
    [  ]  Junior Membership (age 18 & under)
    [  ]  Individual Adult Membership
    [  ]  Family Membership
             Name of family members:
             _________________________________
             _________________________________
             _________________________________
$ 10.00
$ 10.00
$ 20.00
$ 30.00
       
    [  ]  Silver Sponsor
    [  ]  Gold Sponsor

Memberships expire December 31 each year.

$ 100.00
$ 200.00

Please make checks payable and mail to:

CVHA
P.O. Box 10891

Palm Desert, CA  92255-0891