( please print clearly )

I understand that by being a member of the Quincy Saddle Club, I will be representing the club on each outing that I attend. I will be responsible for myself and the people in my party. I will sign a liability release form and agree to follow the By-Laws of the club. Quincy Saddle Club will not be responsible for accidents.

I am requesting to be considered by the Board of Directors for membership for the calendar year __________(If it is September 1 or later, next year is included in the dues.)

Dues are $15 for family membership (members of one household) or $10 for single membership and are to be paid on approval of your membership. Make checks payable to Quincy Saddle Club. You may mail dues and your application to P.O. Box 1203 Quincy 11 62306.

family membership _____ single membership _____

date _____________________

name __________________________________

mailing address _____________________________________________________

city, state, zipcode ___________________________________________________

home phone ___________________________

alternate phone (if applicable) ____________________________

e mail, if we may use to send club information _____________________________________

If this is a family membership, list all family members and their ages. We will need a parent or guardian signature on liability forms for members under 18. Single membership has one vote on club matters, family memberships have 2 votes.

1 ___________________________________ 2 ___________________________________3 ___________________________________ 4 ___________________________________

5 ___________________________________ 6 ___________________________________


Visit our website for more information www.quincysaddleclub.org or call Linda at 217 938 4259


 signatures of board members/ 1                                                2                                                          3                                                           4                                                  or more