Name:_________________________________ ApHC #:_______________________________
Spouse:________________________________ ApHC #:_______________________________
Address:____________________________________________________________
City:___________________________ State:__________ Zip:__________________________
Home Phone:__________________________ Work Phone:________________________________
Fax:_______________________________ Email:_____________________________________
Webpage:____________________________________________________________________________
Non-Pro Names ApHC Non-Pro #
________________________________________ ______________________________________
________________________________________ ______________________________________
Children’s Names Birthday ApHC Youth #
_________________________ ____________________ ____________________________________
_________________________ ____________________ ____________________________________
_________________________ ____________________ ____________________________________
_________________________ ____________________ ____________________________________
Membership dues are payable January 1st of each year. The membership must be carried on
the name of the owner of horse(s) for points in the KsApHC to count for year-end awards. Points do not count until KsApHC
dues are paid and count from that day forward. Only current paid-up members are eligible to vote and hold KsApHC offices.
By my signature, my family and I do agree to abide by the rules of the Kansas Appaloosa Horse Club
and the Appaloosa Horse Club, Inc. I understand that failure to pay debts incurred to KsApHC or any unprofessional or unsportsmanlike
conduct may result in suspension of my membership in KsApHC, subject to review of the Board of Directors of said club.
Dues are: Single $15.00
Family $20.00
Signature of Applicant___________________________________
Make checks payable to the Kansas Appaloosa Horse Club,
c/o Lydia Rostine, 1300 N. Hendricke, Hutchinson, KS 67501
