RIDE INDIANA ENROLLMENT FORM

One horse/One rider

NAME_______________________________ DATE ________________

Current InPHC Member? ____________ Date Joined ________________
 

ADDRESS__________________________________________________
 

CITY __________________________ STATE ________ ZIP _________
 

PHONE (_____) ______-__________ E-MAIL ____________________
 

REGISTERED NAME OF HORSE ______________________________
 

REGISTRATION NUMBER _____________ OWNER ______________
 

Current APHA Member? ________ Enrolled in Ride America? ________
 

Please submit enrollment forms to:

LAURA MASON
6173 WEST - 250 SOUTH
HUNTINGTON, IN. 46750
(260) 468-2642 eves.
pinehollowpnts@earthlink.net
 

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