Information:

Name:

Date of Birth:

Address:

City:

Province:

Postal Code:

Phone #:

Email:

Fees:

Individual Membership

$25

Family Membership

$50 (2 adults) + $10 (per junior member)

Number of Junior Members

Horse & Pony Subscription

$15

Family Members

Name:

DOB:

Name:

DOB:

Name:

DOB:

Name:

DOB:

Name:

DOB:

Atlantic Horse & Pony magazine to be delivered

Different Address than above

Name:

Address:

City:

Province:

Postal Code: