Kentucky Horse Council Membership Application

Membership with the Kentucky Horse Council is offered at a variety of levels to suite your individual needs including individual and family, association, business, farm, and youth memberships.  All Memberships expire on December 31st. View Benefits of Each Membership Type                             4-H / Pony Club Association Business    Equine College Student Farm Individual & Family Non-Profit Youth        Printable Applications 4-H / Pony Club / Association / Non-Profit Business / Farm Equine College Student / Individual / Family / Youth Join Online Below

Section 1: User Information
	Salutation	SELECT ONE Mr. Mrs. Ms. Miss Dr. Prof. Hon.

First Name*

Initials

Last Name*

	Farm, Organization, or School (Student Membership) Name
	Required only for Farm, Business, Association, Rescue Facilities & College Student memberships

	Family Member Names
	If you have chosen a Family Membership, please fill in the names of family members here. Spouses and children 18 years or younger are eligible family members.

Mailing Address*

Address 2

City*

State*

Zip Code*

County

SELECT ONE Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon Madison Magoffin Marion Marshall Martin Mason McCracken McCreary McLean Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenburg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford

E-mail*

E-mail 2

Web Site

	Association Membership
	Please provide the name of the Horse Association you belong to. If it is an Association Member of the Kentucky Horse Council, $10 of your dues will be sent to the association. (Unless you are paying a joint membership)

Display Name

User Name*

Password*

confirm password

Hide in Search

Yes    No

Hide Address

Yes    No

Hide Email

Yes    No

Hide Phone

Yes    No

Phone*

Fax

Section 2: Membership Type
	Membership Type* $150.00 - Business Membership: Small - Less Than 15 Employees $500.00 - Business Membership: Large - 15 Or More Employees $50.00 - Equine Association Membership $55.00 - Family Membership with Insurance $30.00 - Family Membership, No Insurance $50.00 - Farm Membership: Small - Less Than 15 Employees $200.00 - Farm Membership: Large - 15 Or More Employees $35.00 - Individual Membership with Insurance $20.00 - Individual Membership, No Insurance $0.00 - KY College Student - Equine Major $50.00 - Non-Profit Membership $10.00 - Youth Membership $0.00 - Youth Complimentary

Section 3: Payment
	Payment Method*     Credit card     Check

Section 4: Directory Listing
	Your directory listing will be listed in a PUBLIC directory and included in the directory RSS feed for this site. Please do not include private information that you do not want made public in your directory listing.
Use my User Information
	First Name

Last Name

Address

Address 2

City

State

Zip Code

Country

Phone

Phone 2

Fax

Website/URL

E-mail

Category

SELECT ONE Farm Other Associations Business Rescue

Sub Category

SELECT ONE Feed & Tack Store Feed Store Horse Transport Tack Store Trail Access Camping & Related Services Veterinarian General Industry Other

Summary

	Body

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