MEMBERSHIP FORM

LONE STAR PERUVIAN HORSE CLUB


I hereby make Application for Membership in the LSPHC.
I agree to abide by the by-laws and rules & regulations of the club.

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Ranch Name: ____________________________________________________________________________________________


Name: __________________________________________________________________________________________________


Address: ________________________________________________________________________________________________


City: ______________________________________________________State: _____________ Zip: _____________________


Telephone Number (H) _______________________________________ (W) _________________________________________

I would like the following Membership(s):     Please list in the Membership Directory that our ranch has the following:  
____ Life Time ($350.00)      
____ Owner/Breeder ($35.00 per year)   ____ L.S.P.H.C. Membership   ___ Horses For Sale  
____ Aficionado ($15.00 per year)   ____ S.W.P.H.C. Membership   ___ Services Provided  

Signature: ______________________________________________________________________________


Please Print Out This Form, Complete and Mail with Payment to:
Roberta Ellis
c/o Green Gate Ranch
P.O. Box 237
N
ew Ulm, TX 78950

Please Make Checks Payable to the Lone Star Peruvian Horse Club


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