Pennsylvania Horse Breeders Association (PHBA) Membership Enrollment Form
Please enroll me as a member of the PHBA for the 20____ calendar year. Enclosed is a check or money order for $65.00 to pay for my annual dues. DUES ARE NON-REFUNDABLE. In accordance with PHBA’s bylaws, annual membership runs from January through December, annual dues for the calendar year are processed during the specified year, and dues must be paid by March 31st in order to qualify for voting privileges ("Regular Member") and receive magazines. 2008 memberships will be processed after 1/1/2008. (Please type or print all information.) Link below to IRS website for W-9 form requires Adobe Acrobat reader and takes you off PHBA website.
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First Name & Middle Initial
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Last Name
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Farm Name
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Address
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City, State & Zip
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Telephone Number 1 Telephone Number 2
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Fax Number Cell Phone Number
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Member’s SSN or EIN (W-9 Required)
Link to IRS website for W-9: http://www.irs.gov/pub/irs-pdf/fw9.pdf
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Email Address
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Web site Address
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Check Number Amount Enclosed
q Don’t include my name and address on mailing lists for non-PHBA mailings.
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Signature
To join, print membership form, complete FULLY, enclose NON-REFUNDABLE DUES and mail it to us at:
Pennsylvania Horse Breeders Association
701 East Baltimore Pike, Suite E
Kennett Square, PA 19348
Revised 01/04/2008