MEMBERSHIP APPLICATION 2010

OREGON CUTTING HORSE ASSOCIATION

                      □   Single (1 vote) $40.00 Complete section 1 below

                      □   Family (2 vote) $50.00 Complete section 1 & 2 below

                      □   Youth Only $5.00 Complete section 1

□   Renewal                                                        □   New Member

   □   Canadian member please add $25.00 for first-class mailing fee

SECTION 1

  □ Please mark if address or phone number has changed.  A portion of the following information will be listed in the

        directory.

Name _________________________________________  Occupation ________________________________

Ranch Name ________________________________ Address ______________________________________

City _______________________________________  State ________________  Zip ____________________

Home Phone (___)_____________Day Phone (___)_____________Email _____________________________

Please mark all that apply:    □ OWNER    □  TRAINER (A trainer’s list will be published in the directory   

SSN # or Tax ID# _______________________ NCHA # __________________ Non Pro Card Holder? ___________

Do you have accident and/or medical insurance ______ Yes ______ No

Do you have personal and/or liability insurance to insure your personal and/or horse activates_______ Yes ______ No

SECTION 2:  FAMILY MEMBERSHIP

Spouse____________________________________________Occupation_____________________________________

SSN# or Tax ID# ______________________ NCHA# __________________ Non Pro Card Holder? ____________ Please mark all that apply:  □ OWNER        □  NON PRO         □  TRAINER

Children & Dates of Birth___________________________________________________________________________

_________________________________________________________________________________________________

Company ___________________________________________________  Phone (___)__________________________

SECTION 3:  ASSOCIATE MEMBER ONLY

Address __________________________________________________________________________________________

Category:

□ Auto Dealer-Truck Dealer                 □  Fuel                  □  Insurance           □  Motel -Hotel

□  Feed-Tack-Farm Store & Product     □  Horseshoer         □  Real Estate        □  RV-Travel Trailer-Camper

□  Stallion Station-Breeding Farm          □  Horse Trailer       □  Saddle Maker    □  Veterinary

                                  □  Other _______________________________________

SEND DUES PAYMENT TO:  OCHA  42303 Rodgers Mountain Loop, Scio OR 97374     (503) 394-4429