​​​​​​​2018 CNYRHA MEMBERSHIP FORM

Membership expires December 31, 2018





​NAME                                                                              NRHA #


___________________________________________ NRHA#_______________________

  

___________________________________________ NRHA#_______________________


___________________________________________ NRHA#_______________________


___________________________________________ NRHA#_______________________



ADDRESS _____________________


CITY ________________________          STATE ____________ ZIP_______


TELEPHONE _____________________________________________________


EMAIL _________________________________________________________________



  I DO NOT WANT MY ADDRESS SHARED (please check box)


MEMBERSHIP TYPE


( please circle one)

REGULAR:  $ 30.00                FAMILY:  $  50.00.             YOUTH:  $15.00


Family membership includes two adults and one youth member.  Any youth wishing to qualify for Year End Awards other than Youth, must purchase a separate individual, regular membership.



Please make checks payable to:     CNYRHA

Mail to :     CNYRHA/DALE SARGEANT

                  1157 LAKESHORE ROAD

                   CHAZY,NY. 12921


Forms may be emailed with credit card information to :

dalesargeant@icloud.com

If membership is received before January 1,2018 there is a $5.00 discount.