Fillable California State Horsemens Association, Incorporated (California State Horsemen)

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California State Horsemens Association, Incorporated (California State Horsemen)

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Page 1 of 4
Revised 1/2022
California State Horsemen’s Association, Incorporated
1330 W. Robinhood Dr., Suite D
Stockton, CA 95207
(209) 227-7110 Fax (888) 389-0359
californiastatehorsemen@gmail.com
CLUB APPLICATION 20 ___ (
year)
NEW RENEWAL REJOIN
CLUB NAME ___________________________________________________________________________________________
REGION __________ OR CHECK HERE IF CLUB IS LOCATED OUT OF STATE
MAILING ADDRESS
CITY STATE __________ ZIP _____
COUNTY (IF LOCATED IN CA.)
WEBSITE ADDRESS (if applicable)
CLUB CONTACT PERSON
EMAIL ADDRESS
PHONE NUMBER __________________________________
Home
Cell
Work
Fax
ALTERNATE NUMBER __________________________________
Home
Cell
Work
Fax
APPLICATION SUBMISSION REQUIREMENTS
1. Completed Application
2. Form must be signed by Club President or Secretary
3. Submit the club’s membership roster as of December 31
st
of the preceding year. (see
page 4 for details of information to include on roster).
4. Copy of Clubs current Bylaws If NO changes have been made in the last year: check box
Do not need to send a duplicate copy
5. Check or Money Order for the full amount due.
6. Membership will be delinquent if renewal dues are not postmarked by January 31
st
.
__________________________________________________________________ _____________________
SIGNATURE
APPLICATION MUST BE SIGNED TITLE DATE
Page 2 of 4
Revised 1/2022
SELECT ONE TYPE OF CLUB PER APPLICATION
SENIOR CLUB SENIOR Members _____ X $3.50 = $_______
+See below for minimum and maximum club dues
JUNIOR CLUB $50.00 (regardless of the number of junior members) $ 50.00
# ________of Junior Members # of Senior Advisors _______
FAMILY CLUB $3.50 per each Voting Family unit*
Voting Unit(s) _______X $3.50 = $_______
* As defined per a Club’s bylaws
COMBINED CLUB: Senior members, Junior members & Family member voting units*
+See below for minimum and maximum club dues
Senior Members ________ (x) $3.50 (18 yrs or older; include Life & Honorary) = $ ________
Junior members ________ (x) $3.50 (not included in Family membership) = $ ________
Family units ________ (x) $3.50 = $ ________
* As defined per a Club’s bylaws
Administrative Fee( new clubs only) $25.00* $________
Reinstatement Fee $10.00** $
TOTAL Submitted: $ ________
Club descriptions are defined by the CSHA Bylaws Section 2.0 –Types of Membership
DUES: The amount of the club’s dues are based on the number of club members as of
December 31
st
of the preceding year.
+MINIMUM Club Dues $50.00 = Clubs of 14 Members or less/ or a Junior Club
+MAXIMUM Club Dues $500.00 = Clubs with 143 Members or more.
*ADMINISTRATIVE FEE: To be paid by a first time CSHA Member Club
**REINSTATEMENT FEE: To be paid if Club renewal is postmarked after January 31
st
Page 3 of 4
Revised 1/2022
Club Officers
President _____________________________________________________Phone
Mailing Address _______________________________________________ Fax
City _________________________________________________State__________Zip
Email ________________________________________________________Cell #
Vice President _________________________________________________Phone
Mailing Address _______________________________________________ Fax
City _________________________________________________ State _______ Zip
Email ________________________________________________________Cell #
Secretary _____________________________________________________Phone
Mailing Address _______________________________________________ Fax
City State ____Zip
Email ________________________________________________________Cell #
Treasurer _____________________________________________________Phone
Mailing Address _______________________________________________ Fax
City ____________________________________________________State _______ Zip _____________
Email ________________________________________________________Cell # __________________
Club’s Fiscal Year begins: January 1
st
( ) OR: on ______________________
Club Officers are elected or appointed in the Month of: ___________for _______years
Our objectives and/or interests are in the following areas:
___ Drill Team
___ Royalty
___ State Patrol
___ Endurance
___ Ranch Versatility
___ Trails Patrol
___ English/Western
___ Stock Events
___ Trail Riding
___ Gymkhana
___ Ranch Horse/Roping
___ Horsemastership
___ Sorting /Penning
___ Trail Trials
___ Parade
Page 4 of 4
Revised 1/2022
Membership Roster Requirements (may be submitted in Excel format)
1. The club’s roster must be submitted with the application and dues payment.
2. Submit the club’s membership roster as of December 31
st
of the preceding year.
3. List members in alphabetical order by last name. Include the member’s name,
mailing address, telephone number, and membership type for each name.
Membership Type: S = Senior J = Junior F = Family
4. Additions, and/or deletions should be submitted throughout the year to the CSHA
office. Fees for additional members are to be submitted with each updated roster.
OPTIONAL ITEMS
Optional Items
Bylaws/Rule Book (complete book)
$ 35.00
Bylaws/Rule Book (revisions only)
$20.00
Bylaws/Rulebook CD
$ 5.00
Horseman’s Handbook
$ 25.00
West Coast Horse Show Rulebook
$ 20.00
C.S.H.A. Flag
$205.00
C.S.H.A. Shoulder Patch
$ 3.00
C.S.H.A
.
3 ½ ″ Window Decal
$ 3.00
C.S.H.A. 3 ½ ″ Decal
$3.00
C.S.H.A. 9″ Trailer Decal
$ 6.00
C.S.H.A. Lapel Pin
$ 8.00
Donation to CSHA
Donation to a CSHA program*
Shipping & Handling included. Prices subject to change
• Please indicate the CSHA Program to which you wish to donate. CSHA is a 501 (c) (3) non-profit organization.
Part or all of your donation may be tax deductible.
CALIFORNIA STATE HORSEMEN’S CHARITABLE TRUST
Donations to the CSHA Charitable Trust are a tax-deductible contribution 501 (c) ( 3 )
Program Scholarships
$
English
$
Western
$
Gymkhana
$
Horsemastership Junior
$
Horsemastership Senior
$
Royalty
$
Trail Trial
$
UC Davis Veterinary Scholarship
$
Equine Medical Research Fund
$
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