Professional Horsemen's Association of America, Inc.
Application for Junior Membership
Long Island Chapter

Membership Year: Jan 1st-Dec. 31st

Junior Membership - $15.00

Name: _________________________________
Address: _________________________________
City: _________________________________
State: _________ Zip: __________________
Phone: _________________________________
E-mail: _________________________________
Birthdate: _________________________________

Make checks payable to LIPHA

Mail check and application to:

Carol Little
57 Locust Ave.
Farmingville, NY 11738
Ph 631-732- 0235 Fax- call first to send

Print this Page

Close this Page