2017 Individual Membership Application

Membership Type

Membership is Calendar Year, December 1 through November 30. Membership is available year round and remains open until the conclusion of the current horse showing year as per USEF rules. Membership may be made at any MHSA rated horse show and becomes valid immediately upon receipt along with nominations and dues paid in full. Memberships are non-transferable. An individual membership is the property of the named individual regardless of the source of payment and is non-transferable. Membership may be cancelled, but refunds will not be made. New members are vital to the health of any organization so please let us know if you are a new or renewing member. If you are a new member, MHSA welcomes you!

Membership Selection*

Individual Membership $40.00
Family Membership $55.00
Junior Membership $30.00
College Membership $30.00
Life Membership $500.00

Please list the names of each family member nominated*

Horse Nomination Type

Horse Nominations

None
Up to 5 nominations - $20 each
6 or more nominations - $15 each

Number of Nominations*

Please enter a value less than or equal to 25.

Rider Nomination Type

Rider (Dressage and Eventer)

Equitation Rider

Academy Rider

Eventing and/or Dressage Rider - $20 each

Please enter a value between 1 and 25.

H/J and/or SH/P Equitation Rider - $20 each

Please enter a value between 1 and 25.

SH/P Academy Rider and H/J Opportunity Rider - Free

Please enter a value between 1 and 25.

Horse Nominations

Horses must be nominated and shown under their registered name. Any name change must be reported to the MHSA Membership Secretary and also the respective Point Secretary prior to receiving points under the new name.

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Registered Name*

Division (check all that apply):*

Dressage
Eventing
Hunter/Jumper
Show Horse/Ponies

Rider (Dressage and Eventer) Information

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Group*

Age*

(Some divisions are age specific)

Date of Birth*

Equitation Rider Information

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Discipline*

Age*

(Some divisions are age specific)

Date of Birth*

Academy Rider Information

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Age*

(Some divisions are age specific)

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

Name*

First Last

Age*

(Some divisions are age specific)

Date of Birth*

MHSA Scholarship Fund Contribution

Contributions to the MHSA Scholarship Fund College Scholarships are awarded annually to the selected MHSA Junior Medallion Champions. These voluntary payments are not deductible as a charitable contribution. The Scholarship fund and all related Scholarship activities are overseen by the Executive Board and Financial Steering Committee.

Optional Contribution

Year-End Awards Sponsorship

Contributions to MHSA Year-End Awards Sponsorship goes toward the payment of division awards to be presented at the MHSA annual Awards Banquet. These voluntary payments are not deductible as a charitable contribution. These funds and all related activities are overseen by the Executive Board and Financial Steering Committee.

Optional Sponsorship

Full Division Trophy and Ribbons $85
Division Trophy $50
Division Ribbons $35
No Thank You

First Division Choice*

Second Division Choice*

Convenience Fee

$2.00

Total

$0.00

Name

This field is for validation purposes and should be left unchanged.

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2019 Individual Membership and Nominations Application

Step 1 of 2

Application Type

Applicant Information

Barn/Trainer Information

Division Selection

Membership Type

Horse Nomination Type

Rider Nomination Type

Horse Nominations

Rider (Dressage and Eventer) Information

Equitation Rider Information

Academy Rider Information

MHSA Scholarship Fund Contribution

Year-End Awards Sponsorship