EmailMeForm
Membership Form
Membership will not be accepted till paid through the mail by check, PayPal at pbha@centurylink.net (Friends and Family) or Venmo @Mitzi-FrickPBHA. Please contact Mitzi Frick at 360-789-4289 if you have questions.
please follow the instructions on each line.
Name
*
First
Last
Fill out this field for the 1st rider
Additional Family Member
Fill out this field when signing up for a family Membership
Additional Family Member
Fill out this field when signing up for a family Membership
Additional Family Member
Fill out this field when signing up for a family Membership
Address
Street Address
City
State / Province / Region
Postal / Zip Code
Phone
*
###
-
###
-
####
Home Phone
Cell Phone
###
-
###
-
####
Cell Phone if available
Email
*
Confirm
Choose your Membership
Membership is not complete till paid in full.
*
Individual Membership $20
Family Membership $30
Buckaroo Membership Only $10
Choose your Award Fee Options, Awards based on Horse Rider Combination.
*
1st Horse Award Fee $20
2nd Horse Award Fee $20
3rd Horse Award Fee $20
Buckaroo Award Fee $10
Rider and Horse Combination:
Enter the Rider and Horse's Registered Name:
Rider and Horse Combination:
Enter the Rider and Horse's Registered Name:
Rider and Horse Combination:
Enter the Rider and Horse's Registered Name:
Rider and Horse Combination:
Enter the Rider and Horse's Registered Name:
please add your social security number here or be prepared to have it at the 1st race.
Additional instructions or comments:
ie: No Awards fee on Tiny!
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