Horseman Pouter Club
of
North America
Membership Application Form
$20 Family Membership
$15 Regular Membership
$5 Junior Membership
**NOTE - Bulletins are electronic you must submit an email
address.  If you need paper bulletins add $5.00 to your dues

Horseman Pouter Club of North America
Secretary/Treasurer
Charlie Rowe
18923 Crop rd
Riverside, CA 92504
zugbug13@yahoo.com
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The Horseman Pouter Club of
North America
Application for Membership
Name: ______________________________ Date: ______________________
Address: ____________________________ Age (if junior member): ________
City, State Zip: _______________________ Phone: _____________________
Colors Raised: ___________________________________________________
_______________________________________________________________
Other Club Affiliations: _____________________________________________
_______________________________________________________________
E-Mail address: _________________ Web Page URL: ___________________