Membership Application Form
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$25 Family Membership
$20 Regular Membership
$10 Junior Membership
Horseman Pouter Club of North America
Secretary
Thomas Bollinger
15529 Fieldstone Lane
Stewartstown, PA 17363
bollinger_tom@yahoo.com
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The Horseman Pouter Club of
North America
Application for Membership
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Name: ______________________________ Date: ______________________
Address: ____________________________ Age (if junior member): ________
City, State Zip: _______________________ Phone: _____________________
Colors Raised: ___________________________________________________
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Other Club Affiliations: _____________________________________________
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E-Mail address: _________________ Web Page URL: ___________________