2007 SWVADA MEMBERSHIP APPLICATION

DATE: _________________________ NEW __________ RENEWAL __________

NAME ________________________________________________________________________

ADDRESS _____________________________________________________________________

CITY_______________________________ STATE ________ ZIP CODE ___________

HOME PHONE ( ) __________________ WORK PHONE ( ) ___________________

E-MAIL ADDRESS _____________________________________________________________

USDF NO.: ______________________________ (from your USDF Card) Renewing

members must include this information on your application. New members will be assigned a

number by USDF. USDF will mail your membership card.

IS SWVADA YOUR PRIMARY CHAPTER? YES ______ NO ______ IF NO, PLEASE NAME

THE PRIMARY CHAPTER TO WHICH YOU BELONG: _______________________

MEMBERSHIP TYPE:

INDIVIDUAL (SENIOR) $47 _____________

JR/YR (BIRTH DATE ____________ ) $30 _____________

FAMILY: FIRST MEMBER $47 _____________

EA ADD’L MEMBER $30 _____________

NAME _________________

USDF # ____________

Your newsletter is provided to you each month online at our website www.swvada.com.

Please make checks payable to SWVADA and mail with our application form to:

SWVADA Membership Chairperson Office Use Only:

c/o Pat Nelson 07 List ________

846 Mohawk Road Label ________

Long Island, VA 24569 Omnibus ______

Membership is in the Southwest Chapter of the Virginia Dressage Association (VADA). Membership year is December 1 to November 30 and includes a Group Membership in

the United States Dressage Federation (USDF).