Tennessee Valley Dressage and Combined Training Association Membership Application

Primary Member Name:  _________________________________ Birth Date (for Juniors):    _____________

Address:   ______________________________________________________________________________

                 ______________________________________________________________________________

                 ______________________________________________________________________________

Phone: (_____) __________________    E-Mail Address:  ________________________________________

     Membership Type:  Please select either Individual Adult, Individual Junior, or Family Membership and 

     enter appropriate fee.

     ____  Individual Adult Membership ($37) (USDF Dues $17, Club Dues $20)

     ____  Individual Junior (under 21) Membership ($27) (USDF Dues $17, Club Dues $10)

     ____  Family Membership ($45; covers two riders)  (USDF Dues $25, Club Dues $20)

  Secondary Family Member Name: _________________________________

  Birth Date (for Juniors):  _____________

     Additional Family Membership Riders ($10 each) (USDF Dues $8, Club Dues $2)

     ____  Additional Family Rider 1 Name:  ___________________________________

  Birth Date (for Juniors):  _____________

     ____  Additional Family Rider 2 Name:  ___________________________________

  Birth Date (for Juniors):  _____________

       ____  Additional Family Rider 3 Name:  ___________________________________

  Birth Date (for Juniors):  _____________

     ____  Additional Family Rider 4 Name:  ___________________________________

  Birth Date (for Juniors):  _____________

     ____  Total Membership Fee - A portion of your dues will be sent to USDF

     If a new member, how did you find out about TVDCTA?  (Which TVDCTA member should get the credit?)

     ___________________________________________________________________________________________

     ___________________________________________________________________________________________ 

      Are you interested in helping out with:

             Awards - Budgets - Clinics - Shows - Combined Training - Librarian

             Meetings/Programs - Membership - Newsletter - Nominating - Publicity - Volunteers  ?

     Please make checks payable to TVDCTA. - Please submit renewals prior to November 30th.

    Mail to:  Paulette Harrell, 3113 Hale Drive,  Huntsville, AL 35805

    For more information, contact Paulette at (256) 652-4007