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OHIO HORSEMAN’S COUNCIL, Inc. Cuyahoga County Chapter Membership Application For Year 2008__ (Membership is from January 1 to December 31) |
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( ) New ( ) Renewal Member Since __________ |
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The Corral and State Quarterly are included in your membership fee. ( ) I do not want to receive the Corral ( ) I do not want to receive the State Quarterly
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OHC Basic Membership (Without Equine Excess Liability Insurance)
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OHC Plus Membership (With Equine Excess Liability Insurance) |
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Associate Membership |
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Signature (required) _____________________________________ Date ______________________________ (Parent or Guardian Must Sign for Student under age 18 |
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- - - - - - - - - - - - - - - - - - - - - - - - - - - For Chapter Use Only - - - - - - - - - - - - - - - - - - - - - - - - - - - - Amount Enclosed : _______________ Date: ________ Make checks payable to : Cuyahoga County OHC Mail to: Bonnie Evans 1745 Middleton Rd. Hudson, Ohio 44236 ( 330) 650 4933 Membership Card Issued By: ___________Date: __________ Secondary Member’s Primary County ________________ (You may not become a secondary member unless you belong to a primary county. Insurance must be purchased through your primary county)
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Name: ____________________________________ Age ___ Phone : ______________________ Spouse : ___________________________ _______ Age ___ Cell Phone: ___________________ Address:___________________________________________________________________ City: _______________________ State : ____ Zip :______ E-Mail:______________@________ Primary Chapter _________________
Note: Some OHC chapters charge an additional fee to cover costs of chapter newsletters, etc. You may be notified of same by that chapter.
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*Age 62 + as of January 1 |
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If family membership, list names and ages of children under 18 (this is needed for insurance purposes) 1.______________ 2.______________ 3._______________ 4._________________ 5.________________ |
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At –Large: At-Large Members Mail To : Ann Lindimore, State Treasurer 3680 E. St. Rt. 60 N.E. McConnelsville, Oh, 43756 |
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SECONDARY MEMBERSHIP (Must have primary membership in another county) |
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*Age 62+ as of January 1 |
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Type |
Membership Fee |
Chapter Charge |
Total |
Type |
Membership Fee |
Chapter Charge |
Insurance |
Total |
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Single |
$15.00 |
$5.00 |
$20.00 |
Single |
$15.00 |
$5.00 |
$19.00 |
$39.00 |
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Family |
$22.50 |
$5.00 |
$27.50 |
Family |
$22.50 |
$5.00 |
$38.00 |
$65.50 |
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Senior Cit* |
$8.75/ea |
$5.00 |
$13.75($22.50) |
Senior Cit* |
$8.75/ea |
$5.00 |
$19.00 /ea |
$32.75($60.50) |
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Student** |
$12.00 |
$5.00 |
$17.00 |
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No. of Members |
Membership Fee |
Association President/Chairperson |
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$25.00 + $5.00 = $30.00 |
Address (If Different From Above) |
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TYPE |
FEE |
CHAPTER CHARGE |
TOTAL |
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Single |
$10.00 |
$0.00 |
$10.00 |
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Family |
$10.00 |
$0.00 |
$10.00 |
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Sen. Cit.* |
$10.00 |
$0.00 |
$10.00 |