Northern Counties
Cutting Horse Association
Membership Application
Name: ___________________________________________
Spouse: __________________________________________
Children & age: ____________________________________ 
Address: _________________________________________
City: _____________________________________________
State: ___________________ Zip: _______________
Phone: ( ) _______ -
_____________________
Email address: _______________________________
Go Green- Would you like your newsletter emailed 
or mailed
New Renewal Address Change
Family Membership Fee: $45.00.
Membership includes spouse and children under the age of
18.
Print out this form, Fill it out, Mail with your check to:
NCCHA, 6509 Fry Road, Dixon, CA 95620
NOTE: All Owners and Riders Must Be Members.
2010 CLUB YEAR
January 2010 through December 2010
I hereby agree to release and hold harmless NCCHA, it's officers, members, guest or
persons any way connected with NCCHA events from any loss, damage or injury resulting from
my participation in said events.
Signed_______________________________________
Date _________________ |
