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                            2019 Individual Membership and Nominations Application
                        
        
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                                    Application Type
Please check all that apply...
 
I want to...*
								
								Become a new MHSA Member
							

								
								Renew my MHSA Membership
							

								
								Nominate Horses (membership required)
							

								
								Nominate Riders (membership required)
							
Please indicate:*Amateur
Professional
Applicant Information
 
Name*
                            
                                                    
                                                    First
                                               
                            
                                                    
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Age*
(Some divisions are age specific)
Preferred Mailing Address*    
                    
                         
                                        
                                        Street Address
                                    
                                    
                                    City
                                 
                                        
                                        State
                                      
                                    
                                    ZIP Code
                                
                    
                
Email*
                                
                                    
                                    Enter Email
                                
                                
                                    
                                    Confirm Email
                                
                                
                            
FCC Regulations require that MHSA obtain member permission in order to email business correspondence. Additionally, MHSA requests member  permission to communicate using all applicable electronic means.*
								
								I understand that by providing the e-mail above, I hereby consent to receive e-mails sent by or on behalf of the Missouri Horse  Shows Association.
							
Primary Phone*
Alternate Phone
Barn/Trainer Information
 
Affiliation/Barn
Trainer
Division Selection
Check Divisions which you wish to receive show bills and prize lists where your horses and equitation riders are to be nominated.  NOTE:  Show Horses / Ponies Includes: American Saddlebred • Arabian • Missouri Foxtrotter • Morgan • National Show Horse • Open Gaited Breed • Pony • Roadster • Tennessee Walking Horse - Flat Shod • Western
 

								
								Dressage
							

								
								Eventing
							

								
								Hunter / Jumper
							

								
								Show Horses / Ponies
							

								
								SH/P Academy or H/J Opportunity Rider
							
                    
                    
                          
                    
                
                
                    
                        
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 NominationsNone
Up to 5 nominations - $20 each
6 or more nominations - $15 each
Number of Nominations*Please enter a number less than or equal to 25.
Rider Nomination Type
 
Rider (Dressage and Eventer)
Equitation Rider
Academy Rider
Eventing and/or Dressage Rider  - $20 eachPlease enter a number from 1 to 25.
H/J and/or SH/P Equitation Rider - $20 eachPlease enter a number from 1 to 25.
SH/P Academy Rider and H/J Opportunity Rider - FreePlease enter a number from 1 to 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*
                            
                                                    
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Group*
Age*
(Some divisions are age specific)
Date of Birth*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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(Some divisions are age specific)
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Group*
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(Some divisions are age specific)
Date of Birth*
Equitation Rider Information
 
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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Discipline*
Age*
(Some divisions are age specific)
Date of Birth*
Academy Rider Information
 
Name*
                            
                                                    
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Age*
(Some divisions are age specific)
Date of Birth*
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Age*
(Some divisions are age specific)
Date of Birth*
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Age*
(Some divisions are age specific)
Date of Birth*
Name*
                            
                                                    
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(Some divisions are age specific)
Date of Birth*
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Age*
(Some divisions are age specific)
Date of Birth*
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Age*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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Date of Birth*
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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 SponsorshipFull 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
						
					
Email
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