Membership Application

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Date dues Paid ________________

___ Individual Child or Adult Membership $25.00 If Child, enter Date Of birth: __________________

___ Family Membership $35.00 Includes husband, wife & children under 18 as of January 1.  

Name: ______________________                                                                                                                                                   

If Family, Spouse name: _________________________

Child Name: ________________________________ Date of birth: __________________

Child Name: ________________________________ Date of birth: __________________

Child Name: ________________________________ Date of birth: __________________

Member Signature:____________________________________ Date:_______________

Parent or Guardian signature if member is a minor: _______________________________ Date: _____________

Printed name of parent or guardian: _______________________________________________________________

Address, City, State and Zip ____________________________________________________________________

Telephone: _________________Cell _______________ E Mail: _______________________________________

I am willing to help at Contest Shows _____ I am willing to help at pleasure shows _____                                                          I I receive the Corral from another source and do not need another copy. _______                                                                                      Checks Pay to: Wayne County Saddle Club. Mail to P. O. Box 318, Wooster, Ohio 44691

Received by: ________ Amount: _____________Date:__________ Cash ___ Check Number:______