PHBA Membership Dues

PHBA Member Form

Please enroll me as a member of the PHBA for the current calendar year. DUES ARE NON-REFUNDABLE AND NON-TRANSFERABLE. Membership runs from January through December, and dues must be paid by March 31st of the current year. Annual dues for the calendar year are processed during the current year and do not qualify for voting privileges (regular member) or magazine subscriptions. Foal registration discounts only apply to a membership name/entity/TIN name exactly the same as breeder name/entity/TIN name.

Name(Required)

Either Individual or Business Name - exactly as appears on W-9 AND The Jockey Club Certificate

Farm Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Website

Phone(Required)

Cell Phone(Required)

Last 4 SSN or EIN of the breeder account you are paying dues for(Required)

Electronic Signature(Required)

Date(Required)

Member Dues Year(Required)

Please choose one(Required)

Include my name and address on mailing lists for non-PHBA mailings.

Do not include my name and address on mailing lists for non-PHBA mailings.

PHBA Membership(Required)

Full Membership $125

Total

Credit Card