South East Hunter Association, Inc.

  For Office Use Only:
Date: _____________________
SEHA #: __________________
Amount $:__________________
Check #: __________________

 

Name:
Address:
City: Phone:
State: Zip:
Birthdate: Age:
Amateur Please Indicate: 18-35 Over 35  
Horse Name:
Contact Email:
In order for points to count, owner and rider must be an active SEHA member


I hereby apply for membership for the year:
 
Please choose Membership Type:

Individual $30.00
Family $40.00
Life $150.00
Corporate (Farm) $75.00
Life (Farm) $250.00
Please list names to be registered for family membership with birthdates for juniors:

Name: Birthdate:
Name: Birthdate:
Name: Birthdate:
Name: Birthdate:

Please fill out form, print and mail with payment to:
Elaine Fernandes-Powers
PO Box 455
Halifax, MA 02338
Email at: efpowers@comcast.net