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  4 Corners Herding Association
            Membership Form

                           *********  PRINT THIS PAGE AND MAIL IT ***************


Name__________________________________________                                                                
Address  ______________________________________                            
City ______________________
State   _______
 Zip _________

 

Home Phone  ______________________
Cell Phone ______________________
Email address _______________________________




  Dues For July 2011/ July 2012 Club year
        
      Please circle the level of membership you want.


          Individual              Household                     Associate                      Junior

 (1 vote-$20.00)     (2 votes-$30.00)        (No vote-$10.00)       (No vote-$Free)  

Make Checks payable to :  4 Corners Herding
Note on bottom of check  --  4CHAT dues


                    Send Checks to:                Carol Ryther        
(Do not send Cash through the mail.)        7474 E 530 Rd
                                                                    Claremore, OK  74019     
Email: luvmyaussies@yahoo.com