MEMBERSHIP APPLICATION/RENEWAL FORM
Yes I want to Renew or Join the Membership

PLEASE PRINT THIS FORM AND MAIL TO ADDRESS ON THE BOTTOM OF THE FORM


LAST NAME _____________________________FIRST______________________ RANK_______

ADDRESS_________________________________________ LAST 4 DIGITS OF SS#___________

CITY__________________________________________STATE______ZIP CODE______________

PHONE ________-________-________ EMAIL___________________________________________

Period of QuarterHorse service:
Please indicate:      W.W.II   Vietnam   Cold War   Desert Storm   Peace Time   Iraq

1st Date of service with the Quarter Horse: 

       Troop __________Platoon ____________________Section___________

       From __________/__________to __________/__________

2nd Date of service with the Quarter Horse: 
 
      Troop __________Platoon ____________________ Section.___________ 

      From __________/__________to _________ /__________ 

Total number of years in Armed Services___________

Please indicate: 

      Veteran Troopers..........$25.00 Per Year 
  
      Active Duty Troopers......$10.00  Per Year (AD Combat Veterans-1st Year Free)

      Spouse or Child of Deceased Trooper....$15.00  Per Year

      Live Membership for Veterans.....Age 50 and below:		$150.00
                                           51 - 55:		        $140.00
                                           56 - 60:		        $130.00
                                           61 - 65:		        $120.00
                                           66 - 70:		        $110.00
                                           71 and above:		No Charge
 
Membership Card will be mailed within 30 days via U.S. mail to the above address.
  
Membership information will not be made available to third parties without your 
permission.. 

Enclosed is my check or money order payable to the "Society of the Quarter Horse." 
in the amount of  $________.

Please sign _________________________________________   Date_____________________  

Mail this completed application to:
Treasurer
Quarter Horse Society
6645 122nd Ave.
Fennville, MI 49408