Cuyahoga County Chapter of Ohio Horseman's Council
MEMBERSHIP APPLICATION

Please print this form, fill it out and mail to: "to be determined"
Make check payable to: Cuyahoga County OHC

Name Age  Phone Number  New Renewal
Address  City  State  Zip
County Chapter Affiliation  or At Large   E-Mail Address
If Family Membership, #of people  Spouse  Age
Children (under 18) name/age
Corral free of charge? Yes  No  Member of any other County Chapter of OHC? No  Yes
If Yes, Which one
What Equine activites do you engage in the most?
Signature  Date

** Please choose your Membership Choice below **

 Individual Membership state dues $15.00 + county dues $5................$20.00 
 Family Membership state dues $22.50 + county dues $5................$27.50
 Student membership (under 18 yrs of age as of Jan 1) state dues $12.00 + county dues $5................$17.00
 Senior Membership (must be 62 by Jan 1) state dues $12.00 + county dues $5................$16.50
 Associate Membership state dues $25.00 + county dues $5................$30.00
     President's Name Number of Members
AMOUNT ENCLOSED $
 Membership Card Issued By
Date

** Note: Any member's dues which are processed after Oct 1by State OHC are good for the following calendar year

Do you want your name added to the Cuyahoga County published membership list? Yes  No
How did you hear about this chapter of OHC?
Do you Own  Lease  Rent Horses  How Many  Breed  Age
Where do you ride?  Which Metropark reservation?  
When can you ride?

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This page created and maintained by: Lauren Simna