Fillable California State Horsemens Association, Incorporated csha@att.net Renewal - (California State Horsemen)

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California State Horsemens Association, Incorporated csha@att.net Renewal - (California State Horsemen)

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California State Horsemen’s Association, Incorporated
1330 W. Robinhood Dr. Suite D, Stockton, CA 95207
PHONE: 209-227-7110 Fax 888-389-0359
csha@att.net
www.californiastatehorsemen.org
(revised 1/2022)
Year 20 _____ New Renewal Rejoin
Renewal - if postmarked after January 31st is subject to the additional $10.00 reinstatement fee*
Youth 17 & under must join as part of a Family Membership
*Program registration form must be included
Office/Officer/Chairman Use Only
Region
Officer/Chairman signature
Date
Received in Office
Postmark date
Check #
Deposit date | QB updated
Member #
Member Cert mailed
Scanned
Enter the following information if this is a New/Rejoin membership; or if a renewal and the information has changed.
Address
Apt. or Unit #
City
State
Zip
Main Phone
Landline Cell Alternate Phone
Email
County
Check here if out of state member
Check here if legal transfer to Region
MEMBERSHIP TYPES
DUES
Senior (18 years old & over)
$ 35.00
Family (complete page 2)
$ 40.00
Commercial
$ 50.00
Commercial; Web-site Link
$ 250.00
Reinstatement Fee (see above)*
$ 10.00
Total (a)
//////////////////
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 C.S.H.A.
Total (c)
//////////
CHARITABLE TRUST DONATIONS
The Trust is a 501 (c) ( 3 ) non-profit organization
Donations to the Trust are tax deductible
Program Scholarships
Donation
English
$
Western
$
Gymkhana
$
Horsemastership Junior
$
Horsemastership Senior
$
Royalty
$
Trail Trial
$
UC Davis Veterinary Scholarships
$
Equine Medical Research Fund
$
Other – Please indicate below
$
Total (b)
$
Dues (a)
$
Charitable Trust Donation (b)
$
Optional Item(s) (c)
$
Program Registration Fee(s)**
$
Total Due
$
CSHA is a 501 (c) ( 3 ) non-profit organization
Donations to CSHA may be tax deductible in full or in part.
California State Horsemen’s Association, Incorporated
1330 W. Robinhood Dr. Suite D, Stockton, CA 95207
PHONE: 209-227-7110 Fax 888-389-0359
csha@att.net
www.californiastatehorsemen.org
(revised 1/2022)
Family Members
Member
First Name
Last Name
Gender
Relationship*
DOB
Primary Adult
Second Adult
Child/Grandchild
Child/Grandchild
Child/Grandchild
Child/Grandchild
Child/Grandchild
Child/Grandchild
Child/Grandchild
Child/Grandchild
* Relationship to Primary Adult
Family Membership Qualifications:
Two or more persons who meet one of the following qualifications
may apply for a family membership:
a) Any two persons of the same household and/or their children who are juniors.
b) Any two persons who reside in the same household;
c) Any adult and his/her children/grandchildren who are juniors.
The adult must be the parent or legal guardian of the children/grandchildren.
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California State Horsemens Association, Incorporated csha@att.net Renewal - (California State Horsemen)

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Completed 2 January 2022

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