Membership Application

Please complete the form below if you would like to become a member of the Indiana Horse Council. You may also renew memberships on-line with this form. (* = required fields)

This is a New Application     Renewal
First Name *  
Last Name *  
Business/Association Name
(if applicable)		  
Address *  
City *  
State *  
Zip Code *  
Telephone  
E-mail  
Membership Type
(and dues owed)
Lifetime $200 Youth $15
Individual with Insurance $45 Business $100
Individual with NO Insurance $25 Association $75
Family with Insurance $75  
Family with NO Insurance $35  
Type of Credit Card
Card Number
Expiration Date
Cardholder Signature (Checking this box represents my signature if submitting on-line)

_________________________________________
I am interested in:
(check all that apply)
Trail Riding Horse Shows
Hoosier Horse Fair Government Affairs
Animal Welfare Therapeutic Riding
Indiana State Fair Youth Team Challenge
Indy 500 Festival Parade Publicity

 

Indiana Horse Council
225 S. East, Suite 738
Indianapolis, IN 46202
(317) 692-7153 fax