APPLICATION FOR MEMBERSHIP
Membership is valid for one year from application date
ID# will be issued at time of processing NEW applications & will remain with you for life
Renewal dues should be received within 30 days of anniversary
One form can be completed for the entire family (living under the same roof)
Dues are $35 (for single) or $50 (for family), payable at the time of application
Application Date *
MM
/
DD
/
YYYY
Reason *
New Membership
Renewal / Information Update
Type
ID#
Enter if renewing & know your number, otherwise this will be assigned/entered by an officer.
Street Address *
City *
State *
Zip Code *
Primary Member - Full Name *
Primary Member - Date of Birth *
MM
/
DD
Primary Member - Phone # *
Primary Member - Email Address *
Family Members
Please complete the fields below to the best of your ability for each additional member.
Adult Family Member - Full Name
Adult Family Member - Date of Birth
MM
/
DD
Adult Family Member - Phone #
Adult Family Member - Email Address
Family Member (1st Youth) - Full Name
Family Member (1st Youth) - Date of Birth
MM
/
DD
Family Member (2nd Youth) - Full Name
Family Member (2nd Youth) - Date of Birth
MM
/
DD
Family Member (3rd Youth) - Full Name
Family Member (3rd Youth) - Date of Birth
MM
/
DD
Family Member (4th Youth) - Full Name
Family Member (4th Youth) - Date of Birth
MM
/
DD
Parent / Legal Guardian
If the Primary Member is under 18yrs old, parent/legal guardian MUST submit the following.
Parent's Name
Parent's Email
(if different from above email address)
Parent's Phone
(if different from above phone number)
https://www.paypal.me/chatthaclub
Use the link above to pay for your membership fee (include your name & email in the notes). If you cannot pay the fees to PayPal, please contact hopiwan@me.com to make other arrangements.
Completion of form
By clicking "Submit" below, I hereby agree to abide by and enforce the rules and regulations of the Chattahoochee Horse Archers, Inc.. By participating in a CHA event, I am agreeing that images of my horse, equipment and myself may be photographed, videoed or recorded in any way and re-used without my permission and without compensation.
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