SUMMIT RIDERS HORSEMAN’S ASSOCIATION, INC. Membership Application

Check type of membership and circle dollar amount applicable

1st-time Individual membership $30
- 1st time members, please tell how you learned about the club?
- ___________________________________________________
Individual renewal membership if paid by Feb. 1 $25
Individual renewal membership if paid after Feb. 1 $35
Family membership includes all dependents as defined by IRS
1st-time Family membership $35
Family renewal membership if paid by Feb. 1 $30
Family renewal membership if paid after Feb. 1 $40
Out of state membership $15

Member Information (Head of Household):

Last name: ______________________ First name: _____________________

Street: ________________________________________________________

City: ___________________________ State: ___________Zip: ___________

Home Phone: ____________________Cell Phone: _____________________

Email address: __________________________________________________

Member Information (Partner):

Last name: ______________________ First name: _____________________

Street: ________________________________________________________

City: ___________________________ State: ___________Zip: ___________

Home Phone: ____________________Cell Phone: _____________________

Email address: __________________________________________________

Children’s name(s) and age(s):

Last name: ______________________ First name: __________________ Age: _____

Signature: _______________________________________ Date: _____/_____/_____

Please mail application and check made payable to S.R.H.A. to:

Melany Moore - 25000 Hutchinson Rd - Los Gatos, CA 95033

Or pay via Zelle and send forms: summitriders23@gmail.com

Liability Release must be signed each year and by each person included in membership.

Please make copies as needed.

Updated September 2022