Fallon horsemen’s Association
Membership Application
Date of Membership: ___________________________________________
Name: ______________________________________________________
City: ___________________ State: _______ Zip code:_______________
Telephone Number: ___________________________________________
Email Address: _______________________________________________
Type of Membership: (Please circle the dollar amount enclosed.)
Adult/Individual $20.00
Individual Youth $15.00
(Must have parent’s signature)
Family $30.00
If you have chosen a Family Membership, please list family members:
__________________________ ____________________________
__________________________ ____________________________
Please make check payable to: Fallon horsemen’s Association
PO Box 1882
Fallon, NV 89407
Attn: Treasurer
For further information, write the address above or email the club at: