2010 IPHA MEMBERSHIP FORM       

Please send to: Rita Hankins, 600 S Bartlett Rd, Bartlett, IL 60103

 

 

Name  _________________________________________________Date:_________________

 

Address         _________________________________________________________________

 

City, State, Zip                   ___________________________________________________________

 

Phone _____________________     Email _________________________________________

 

 

Type(circle one):  Youth~$10      Single~$15.00    Family~$20.00

                                                                                                              *see by-laws for family classification*

 

Please list children’s names, birthdays and APHA Youth Numbers below:

 

          Name                               Birthdate                      APHA Youth Number

          _____________________     __________________     __________________________

          _____________________     __________________     __________________________

          _____________________     __________________     __________________________

          _____________________     __________________     __________________________

 

 

Reminder:  APHA membership is now required for all exhibitors to show.

 

Please list all individuals names and 2010 APHA membership numbers who will be showing at the IPHA shows this year.

 

          Name                                                                APHA Membership Number

          _________________________________________      __________________________

          _________________________________________      __________________________

          _________________________________________      __________________________

          _________________________________________      __________________________

 

Laminated “Permanent” Numbers

We also sell permanent numbers each year with all proceeds going to the Youth Club.  Anyone who purchased numbers last year can keep the same number(s).  If you would like to purchase numbers for 2010, please indicate what numbers you would like below, and  include $5.00 for each number you want.  If that number is available, we will have the number laminated and available for you at the first show. (If not purchased by June 1^st, the # will be released.)

 

Numbers wanted: 1^st choice________________________2^nd choice:_______________________

 

Total amount enclosed:   $_____________ Check #__________________________