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MPHC & MJPHC MEMBERSHIP APPLICATION
Name(s):________________________________________________________________
DOB
(optional, unless Youth):___________________
Address:______________________________________
Home
Phone:___________________
City,
ST, Zip:__________________________________ Bus.
Phone:__________________
Email:
______________________________________
Web
site: ______________________________________
Additional Members (Date of Birth Required for youth 18
and Under)
Name:_______________________________________
DOB:___________________
Name:_______________________________________
DOB:___________________
Name:_______________________________________
DOB:___________________
TYPES
OF MEMBERSHIP:
Youth 18 & Under: $10.00________
One Adult: $20.00________
Family: $30.00________
(Membership includes subscription to The Wrangler)
DATE:
________________________ TOTAL AMOUNT ENCLOSED
$__________________
MAKE CHECKS PAYABLE TO: MONTANA
PAINT HORSE CLUB
MAIL
TO: Dawn Westre
PO Box 41
Reed Point, MT 59069
Rev 10/06
For a printable version of this form
CLICK HERE
Rev 1/05
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