AIKEN EQUINE ALLIANCE
INFORMATION & EQUINE INTEREST FORM

LAST NAME: FIRST NAME: PREFIX : DOB:	MAILING ADDRESS:
SPOUSE NAME:	WEB SITE: www.
HOME TEL#:	E-MAIL:
OFFICE TEL#: CELL TEL#: FAX#:	COMPANY OR STABLE:
AREAS OF EQUINE INTEREST	EQUINE QUALIFICATIONS:
COMMENTS or NOTES:	AIKEN CONTACT INFO:
ASSOCIATE ANNUAL FEES [__] $ 5.00 Student Associate [__] $ 20.00 Regular Associate [__] $ 50.00 Professional Associate [__] $100.00 Sponsor Associate CLICK HERE FOR MORE ABOUT ASSOCIATE FEES	The above information may be used for official Aiken Equine Alliance business only. . ___________________________ Signature

Attach additional pages to this form as needed.
PRINT, COMPLETE, AND SIGN THIS FORM. MAIL WITH YOUR CHECK
IN THE AMOUNT OF THE TYPE OF ASSOCIATE YOU SELECTED TO:
Aiken Equine Alliance, 252 Willow Lake Drive, Aiken, SC 29803
CHECKS SHOULD BE PAYABLE TO: Aiken Equine Alliance