Wufoo

Membership Type *
Individual adult $22 Family $44 Youth/Junior only (18 & under) $15.00 Individual lifetime $250 Ride Veterinarian $0 Other, please specify
Name #1 * First Last
Note: If you are a NEW member, please write NEW after your last name. Youth/Junior - please provide Birth Year
Name #2 First Last
Other family members, Youth/Junior (indicate birth year, under 18 yrs old at Dec 31 2011)

List 1 per line,
Youth or Junior (birth year)
eg. Jan Doe (Y/Jr 1999)
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *

Enter accurately - will be used to confirm receipt of your application
Phone Number * ### - ### - ####
Horse Council BC - Select one: *
I/we have a 2012 HCBC membership / in their database I/we will join HCBC shortly and will advise ERABC I am a non-riding member Other

Note: For insurance reasons, ERABC membership is NOT current for riding members until HCBC membership is confirmed.
I will submit this amount: * $ Dollars . Cents
No funds will be submitted with this form. A follow-up email will provide payment instructions.
I/we will pay by: *
PayPal Cheque

Instructions will be emailed to you for each of these options.
Do Not Fill This Out

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