United Performance Racking Horse Breeders & Trainers

Association

2010 Membership Application

__Individual - $35.00

__Family - $50.00  (Husband, Wife, Children under 18)

__Pro__Amateur__Juvenile__Non Exhibitor

Show Status Card Only - $20.00__Pro __ Amateur __ Juvenile

Name___________________________Date of Birth_________

__"____________________________________"_______________

__"____________________________________"_______________

Address___________________________Zip________

Phone #H.___________________B._______________

E-mail Address________________________________

Payable to UPRHBTA

c/o

Lesley Anderson

6290 Raccoon, Rd.

Raccoon, Ky. 41557