Iowa Draft Pony Membership Form

MEMBERSHIP REGISTRATION

Dues are $15.00 per Farm, Family or Individual.

DATE:_____________________    AMOUNT PAID_______________  CHECK #__________

KEEP THIS PORTION. THIS IS YOUR RECEIPT

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DATE:___________________                   AMOUNT PAID____________________________

NAME:________________________________________________________________________

FARM NAME:__________________________________________________________________

ADDRESS:_____________________________________________________________________

ADDRESS:_____________________________________________________________________

PHONE:_______________________________________________________________________

EMAIL:________________________________________________________________________

WEBSITE:______________________________________________________________________

EQUINES OWN: (HOW MANY, BREEDS & GENDER)
___________________________________________________________________________________

___________________________________________________________________________________

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Please make check payable to: Iowa Draft Pony Hitch Association & mail with form to: 

Shirley Wolf
c/o IDPHA
 3725 Zearing Ave
Farnhamville, IA 50538