Great Lakes Icelandic Horse Association

Application for membership

Annual dues for GLIHA Ice Tolters are:
25 - Single membership
35 - Family membership (includes spouse and children up to 18 years of age)
Dues are due Jan 1st of each year.
Please complete this form, print it, and send it to:

GLIHA Ice Tolters
c/o Hope Ellis, Treasurer
3470 Ray Road
Oxford, MI 48370

*** Please make all checks payable to: GLIHA Ice Tolters.***

                 Sorry, credit cards or foreign monies accepted.

Date    ________________

Name  ________________________________________________________________

Farm Name (if applicable:   ___________________________________________________

Street Address          ________________________________________________________________

City      ________________________________________________  State  ____________ 

Zip:  __________________________  Country ________________________

Phone Number(s)  ____________________________

Fax (if applicable)  ____________________________

E-Mail(s)  _______________________________________________________________

Member of the USIHC?   Yes ______ No  ______

Do you currently own an Icelandic Horse?  Yes  ____  No  ____  How many? _______

Are they registered with the USIHC?  Yes  ____  No  ____

Type of membership:  Individual  ____  Family  ____

How would you like to be notified of receipt of your membership dues?

            E-mail  ____                Postal mail  ____

Additional family members names  __________________________________________

________________________________________________________________________

Additional Notes  __________________________________________________________________________________