ECBG Online Membership Form

NOTE: Any membership that is activated after December 10, 2006 will apply to the 2007 calendar year.

Name: Phone: Email:

Farm/Business Name:

Address:

City: State: Zip:

Website Address:

I am a (please check all that apply):   Breeder     Trainer   Professional   Amateur   Broker  

I have:   1-5 horses     5-10 horses     10+ horses  

Which consist of (insert numerical value):

    Breeding : Foal(s)     Broodmare(s)     Stallion(s) 

    Riding   :   Mare(s)    Stallion(s)           Gelding(s)

I breed / support the following registries (please check all that apply):

AHS ATA  ASPR AWR  AWS BWP  GOV ISR/OLDna JC/PHR NAWPN  RHPSI  SWANA Other   (please specify):

All new members are eligible and unless ECBG is otherwise informed, will be added to the ECBG member list.

If you would prefer to not have you name/ Information shown, or only limited information viewable on our online member list, please clarify what info you would like shown:

            Adults:                                      $60.00  

            Youth (Under 18 as of Jan. 1):          $30.00  

            Family/Private Farm (No tax ID):    $75.00  

            Business/Farm (Have Tax ID#):      $100.00

            Adults:                                      $30.00  

            Youth (Under 18 as of Jan. 1):          $15.00  

            Family/Private Farm (No tax ID):    $50.00