2007 East Coast Regional Dressage Association
Membership Application


Date:____________________________
New Member:_______________
New Address/Phone:_____________________ Renewal:_____________



Name:_______________________________________________________________________________________________________________________


Address:____________________________________________________________________________________________________________________


E-Mail Address:_________________________________________________ Trainer:___________________________________________________


Telephone: ________________________________

D.O.B._______________________Is ECRDA your Primary G.M.O?___YES___NO___

Life Membership:
 $500.00
Senior Individual:
 $45.00
Golden Cup:
 $45.00
Junior Individual:
 $40.00
Family Membership:
 $45.00 for the first person. $20.00 for each family member living at the same address.


Name:________________________________ DOB:______________________ JR / SR / GC

Name:________________________________ DOB:______________________ JR / SR / GC

Name:________________________________ DOB:______________________ JR / SR / GC

Name:________________________________ DOB:______________________ JR / SR / GC

Business Affiliate (Chose One)
$85.00 / Year for Business Card Ad
$170.00 / Year for 1/4 Page Ad
$250.00 / Year for 1/2 Page Ad
$450.00 / Year for Full Page Ad

Yes, I would like to contribute to the ECRDA Scholarship Fund! Enclosed is my donation of:
$5.00
 $10.00
 $25.00
 Other


Please make checks payable to ECRDA
Mail to: Iris Furlong 5 Stanley Place, Jackson NJ 08527