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Last Name: ______________________ First: ______________ Spouse: _____________________ Farm or Prefix: ____________________________________________________________________ Address: _________________________________________________________________________ City: ____________________________________ State: __________ Zip: ____________________ Telephone: __________________________ e-mail: ______________________________________ Children: First Name: ___________________________ Age:_______ First Name: ___________________________ Age:_______ First Name: ___________________________ Age:_______ Family Membership (Two Votes) - $25.00 Single Membership (One Vote) - $20.00 Lifetime Membership (Individual) - $200.00
Make check Payable to M.H.B.E.A. Amount Paid:_________________________ Date: ________________________ Signature:____________________________ To participate as a Club Member, please circle the committees or areas you would be willing to serve during this calendar year:
Membership Newsletter Publicity Promotion Juniors Other Morgan Medallion Show Committee Club Events Other
Make check payable to MHBEA and mail to: . Penny Lalwtos _ 801 Adelaine Avenue _ South Pasadena, CA 91030 . .
See next page for listing of your horses - _ please fill out LISTING OF HORSESDate: ______________________________ Name of Farm: _______________________________________________________________ YEAR HORSES NAME REG # COLOR SEX FOALED SIRE DAM
B=Bay BRN = Brown BLK = Black CH = Chestnut M=Mare S = Stallion G = Gelding
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