Join VQHA Online Membership Form

Virginia Quarter Horse Association : Membership Application
Full Name: *
Birth Date
AQHA Number *
Expires: *
E-mail: *
Select One: *	Open Amateur Novice Amateur
Phone: *
Address: *
City: *
State: *
Zip Code: *
Back No. Request:

Spouse Name
(if family membership)

Youth Name:
Birth Date
AQHA Number
Back No. Request:
Please Select One:	Youth Novice Youth
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Youth Name:
Birth Date
AQHA Number:
Back No. Request:
Please Select One	Youth Novice Youth
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Youth Name:
Birth Date
AQHA Number:
Back No. Request:
Please Select One:	Youth Novice Youth

Please select appropriate options:
(will total as you select)
Note: For Youth and Amateur Memberships you MUST pay the Individual Membership Fee in addition to the Youth or Amateur Membership fee for your points to count towards year-end awards.
VQHA Membership:	Individual Membership - 1 year ($35) Individual Membership #2 - 1 year ($35) Individual Membership - 3 years ($90) Individual Life Membership ($250) Family Membership - 1 year ($45) Family Membership - 3 years ($125) Amateur Membership - 1 year ($10) Youth Membership #1 - 1 year ($5) Youth Membership #2 - 1 year ($5) Youth Membership #3 - 1 year ($5) Senior Membership (65 and Over - after 5 consecutive years of paid membership) ($0) No Frills Futurity - ability to show in VQHA Futurity, no other member benefits ($15) Back Number #1 - 1 year (proceeds benefit Amateur Association) ($25) Back Number #2 - 1 year (proceeds benefit Amateur Association) ($25) Back Number #3 - 1 year (proceeds benefit Amateur Association) ($25) Back Number #4 - 1 year (proceeds benefit Amateur Association) ($25) Newsletter via US Postal Service ($5) Additional VQHA Decal ($3) Total : $0
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Memberships run from January 1 to December 31 of current year. If you do not join by January 1, memberships run from postmark to December 31 of current year.
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Please review the information above carefully before you click submit. Clicking submit will take you to Google® Checkout where you can pay online with a credit/debit card. It's very safe and secure. If you have Membership questions, please contact Buffy Hicks at 703-801-2133 or via email at zipthathotrod@aol.com. Thank you.
Just so we know you're a person and not a computer *

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