NORTHERN NEVADA GAITED HORSE CLUB
Membership Application

Carole Hays (702) 849-9014
________________________________________________________

Membership extends from January 1 through December 31.  Please fill out this application completely and be sure to sign and attach the release of liability on the reverse side of this form.   Family memberships must have signatures of all members.  Owners of non-gaited horses welcome.  If you wish, you may pay for two years at this time.

Please mark and fill in appropriate box.
Family (2 votes)                 $45.00 ____
Mr.
Ms.
Mrs.

Spouse or Family Members
__________________________________

_________________________________

_________________________________		 Single (1 vote)                     $30.00 ____

Mr.
Ms.
Mrs._____________________________

 

Address:
Street: ______________________________________________________________

City_______________________________  NV _______________  Zip ____________

Telephone: _____________________

Number of Gaited Horses Owned ___________
_________________________________________________________________________

Signature ______________________________________________
_________________________________________________________________________

Amount Enclosed ____________________  Check ________  Cash ___________
_________________________________________________________________________

Make Checks Payable & Mail Membership Application & NNGHC Release of Liability forms to:
To Release of Libility Form

NNGHC
% Carole Hays
15715 Fawn Lane
Reno, NV 89511
_________________________________________________________________________
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