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MID-PEN HORSE SHOW ASSOCIATION

Membership & Registration Form


MEMBERSHIP
$50.00
Name/Family/Farm

Individual = $25

Farm/Family =

_______________________________________________________________

Name of Rider
_______________________________________________________________
Name of Rider
_______________________________________________________________
Name of Rider
_______________________________________________________________
Address
_______________________________________________________________
City

_________________________ State _________________________ Zip _____________

Phone _______________________________ Email ____________________________________


Name of Parent/Guardian (if junior)
___________________________________________________
Signature (Parent /Guardian, if junior)
_________________________________________________
HORSE/PONY REGISTRATION
Name of Horse/Pony _______________________________________________________________
Color______________________ Hgt _____________________Sex ______________ Age
_________
Owner ___________________________________________________________________________
Name of Horse/Pony _______________________________________________________________
Color______________________ Hgt _____________________Sex ______________ Age
_________
Owner ___________________________________________________________________________
Name of Horse/Pony _______________________________________________________________

Color______________________ Hgt _____________________Sex ______________ Age


_________
Owner ___________________________________________________________________________

***Please remember, you must register as a member of MPHSA in


order to register your horse/pony for points. Riders, please
remember you must register as a member to collect points even if
the horse/pony is already registered with a Farm. Please make checks
to the MPHSA. If you wish to mail your registration in early, please mail forms
WITH CHECKS to Sunrise Farm, 5758 Fletcher Road, Gloucester Virginia 23061.
Forms received without checks will not be accepted or recorded.

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