2016 IAA Membership Application
Check as appropriate: New_______ Renewal_______
Changes on form for renewals_________
Farm Name __________________________________________________________________
Name ______________________________________________________________________
Address___________________________City____________________State_____Zip_________
Email Address_________________________ Telephone ______________________________
The following is required for Family Memberships only:
Spouse's name _______________________________
Child's name ________________________________ Birthdate______________
Child's name ________________________________ Birthdate ______________
If you own Appaloosas, please indicate number owned ______
Other horses ________
Please indicate your areas of interest:
- Breeding
A. Standing a stallion___
- Showing
A. Youth ___
B. Performance ___
C. Non-Pro ___
D. Halter ____
E. Open Shows ___
- Competitive Trail Riding___
- Racing___
- Pleasure Riding___
- Futurities
A. Halter___
B. Pleasure____
- Endurance Riding ___
- Other (please list)
______________________
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Are you willing to help at IAA-sponsored events
(shows, etc.)?
__Yes __No
Suggestions or comments:
Please list the ApHC members in your household and their ApHC numbers:
_________________________________________________________
_________________________________________________________
_________________________________________________________
I wish the above information to remain confidential.
_____Yes _____No |
Annual membership fees:
_____ Individual - $20 ____ Family - $25 __ Youth Membership - $15
Please make checks payable to IAA. Payment must accompany application!
Mail checks and this completed application to:
IAA c/o Janice Conner
1589 W 225 S
Winamac, IN 46996
As a member of the Indiana Appaloosa Association, Inc., I do hereby pledge to abide by its
rules and regulations and to promote the bloodlines of the Appaloosa horse to the best of
my ability.
Signed_________________________________________________________
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