LAST NAME:_________________________________  FIRST NAME:______________________________

FARM/RANCH NAME:___________________________________________ APHA #: _________________

ADDRESS:____________________________________________________________________________

PHONE: (HM)______________________ (WK)____________________ (CELL)______________________

EMAIL:______________________________________________________________________________

*FOR POINT KEEPING PURPOSES, please list ALL Family members showing horses under your membership, including Youth & Amateur along with their Youth and Amateur Numbers and Date of Birth.  

  ** Points for STPHC will be determined by placings at STPHC approved/sponsored shows.  Dues must be paid before club points will be awarded. POINTS ACCUMULATED BEFORE PAYMENT OF DUES WILL BE LOST. Club Rules are posted at:  www.Southtexaspainthorseclub.com                                             

  Make Checks Payable to: STPHC                          Send Forms/Checks to:          South Texas Paint Horse                                                                                                                                                                                 1007 Vivroux Ranch Road                                                                                                                                                                                 Seguin , TX  78155                                                                                                                                                                                 Attn:  Cathy Sasser

  Mailings:  Please circle Y or N to receive club mailings & type of mailing:  Newsletters, Voting For Club Board Members, Futurity Information.  

PAYMENT RECEIPT INFORMATION  

Amount Paid:  ________ -   I/F    R   Y            Date Paid:___________        NEW or RENEWAL    

Cash or Check & # _________                Received By:______________________________