Buxmont Riding Club

Membership Application

PLEASE PRINT CLEARLY

Name

Date of Application

Spouse's Name

Child/Children's Name (age 17 & under)

Age

Date of Birth

Address

City

State

Zip

Phone Number

Cell Number

E-Mail Address (if applicable)

Number of Horses in your family

Type of horses:

What is your interest in the Buxmont Riding Club?

Do you belong to any other Clubs, if so which ones?

Where/How did you hear about Buxmont Riding Club?

Please circle the membership you are signing up for:

$30

SINGLE - an individual that is 18 yrs or older

$35

DUAL - 2 people - at least 1 of whom is 18yrs or older & both

live under the same roof

$45

FAMILY - 3 or more people - at least 1 of whom is 18 yrs or older

and all live under same roof

Make checks payable to Buxmont Riding Club. Please mail your check along with

this application to Buxmont Riding Club, Attn: Membership, PO Box 113, Tylersport PA 18971-0113

The Buxmont Riding Club depends on VOLUNTEERISM. In order to match your interest and skills with the functions

needed to maintain the club, PLEASE rate the following as to what you can be involved in:

0 - Cannot do, 1 - Will try to help, 2 - Will help

Banquet

Fundraising

Show Booth (registration)

Building/Grounds upkeep

Gate help

Western and/or English Show

Data Show Entry

Gymkhana Show help

Set up Trail Rides

Driving Show help

Points Keeper

Western Show help

English Show help

Ribbon Setup/Runner

Workshops/Clinics setup

Food Booth

Ring Master

Do you have a child(ren) interested in our Junior Program?

YES

A Probationary Member on:

Date Dues Paid:

An Active Member on:

Check Number:

Membership Committee Member:

Cash $

Dues Received by:

Treasurer: