Kansas Horse Council Information Book

Kansas Horse Council Membership/Merchandise Membership Year is Jan.1-Dec. 31

Official Sponsor

Name: _______________________________________________________ Date: _____/_____/_____

Spouse Name: (for Family memberships) ____________________________ Phone: (_____) ______________

Mailing Address: ___________________________________ City: ____________________________

State: ___________________________ Zip: ____________ County: ________________________

E-Mail: ________________________________________ Number of horses owned: ___________

What types of horse activities most interest you? ____________________________________________

Memberships

Cost Total

Individual

(Includes $1,000,000 Personal Liability Insurance)

$50.00

$

Family – Individual + spouse/partner + children under 18

(Includes$1,000,000 Family Liability Insurance)

$80.00

$

College Student (Copy of student ID required) Under 18 must have parent or guardian signature & insurance will be listed under parents name. Parent Signature: ________________________

$35.00

$

Life time / Individual

Liability insurance optional @ $20 per year.

$250.00

$

Lifetime / Family (husband, wife & children under 18)

Liability insurance optional @ $40 per year.

$400.00

$

Club

(no insurance) # of club members: ___________

$35.00

$

Total

$

Merchandise

$30.00 KHC Member $40.00 Non-member

$

Equine/Livestock Limited Liability Law Warning Sign

or Agri-Tourism Sign Tax & S/H included in price

$

Equestrian Trails in Kansas

$3.00

$

Apparel – Hoodies, Caps, Jackets

$

_______ $5.00 ______ $10.00

I would you like to make a tax deductible donation to the Kansas

Horse Council Foundation for student scholarships.

_______ $25.00 ______ Other

To receive a certificate for tax purposes please submit a separate check

made out to the Kansas Horse Council Foundation. If no deduction is

TOTAL $

needed please include donation with membership payment.

Credit Card : Visa / MasterCard / Discover

Ch eck # : ______________

# ______________________________________________________ Exp. Date: ______________ 3 digit code: _______

Kansas Horse Council ~ 8831 Quail Lane, Ste. 201 ~ Manhattan, KS 66502 ~ 785-776-0662 ~ director@kansashorsecouncil.com ~ kansashorsecouncil.com