BIG SKY EQUESTRIAN ASSOCIATION
2005 MEMBERSHIP FORM

Name:
Address:
City, State Zip:
Email:
Phone #:
Work/Cell #:
Birth Date:
Equestrian Interests:
Amateur Status: (yes for most, no for those who coach or train)
Additional Members (if family membership):
I would prefer BSEA use the following method to communicate with me (circle one): Regular mail via USPO (costs BSEA) E-mail and web site (free to BSEA) Both

(circle all that apply): I do not want to be included in a BSEA Member Roster BSEA may include my address in a BSEA Member Roster BSEA may include my phone number in a BSEA Member Roster BSEA may include my e-mail address in a BSEA Member Roster

Membership - Circle $ amount of membership you want Postmarked on or before 1/1/05 Postmarked after 1/1/05
Single Membership - Entitles one person to USDF-GMO membership and MSEA membership $40.00 $45.00
Family Membership - Entitles the family members of a single household to one USDF-GMO membership and a family MSEA membership $45.00 $50.00

Make checks payable to BSEA and mail to:
Katharine Staples, Treasurer, P.O. Box 567, Billings, MT 59103
406-245-7605 [email protected]
THANK YOU FOR YOUR SUPPORT!