Membership Form

Member Name*

Prefix First Last Suffix

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Phone*

Alternate Phone

Email*

NRHA Membership ID*

Would you support EPRHA by sponsoring a show trophy?

Yes
No

Division (s)*

Open
Non Pro
Youth
Associate

Membership Type*

New
Renewal

Choose your membership category*

Regular $45
Youth $15
Associate (non-rider) $25

Method of Payment*

Mailing a check (you must print and mail with your check)
Pay Online (you must pay on submission)

Submit this form and then please make checks payable to: “EPRHA"

Mail your application and payment to: Jennifer Geedy 8820 Carlisle Road, Wellsville, PA 17365

*Membership is for one calendar year.
*Points toward year-end awards begin upon receipt of this form with payment.
Earnings prior to receipt of membership DO NOT COUNT towards year-end awards.
Owner and Rider MUST be members for year-end award eligibility!

Signature

CAPTCHA

Total

$0.00

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