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