APPLICATION FOR CHA MEMBERSHIP
Annual membership is valid from the application date and receipt of payment.
One form can be completed for the entire family (living under the same roof)
Dues are $35 (for single) or $50 (for family), payable at the time of application
*5 year membership-$150 for single, $200 for Family
*10 year membership- $300 for single, $400 for Family
Adres e-mail *
Application Date *
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I am applying for... *
New Membership
Renewal / Information Update
5 Year Membership
10 Year Membership
Individual
Family
Street Address *
City *
State *
Zip Code *
Primary Member - Full Name *
Primary Member - Date of Birth
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Primary Member - Phone # *
Primary Member - Email Address *
Adult Family Member - Full Name
Adult Family Member - Date of Birth
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Adult Family Member - Phone #
Adult Family Member - Email Address
Family Member (1st Youth) - Full Name
Family Member (1st Youth) - Date of Birth
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Family Member (2nd Youth) - Full Name
Family Member (2nd Youth) - Date of Birth
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Family Member (3rd Youth) - Full Name
Family Member (3rd Youth) - Date of Birth
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Family Member (4th Youth) - Full Name
Family Member (4th Youth) - Date of Birth
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Parent's Name
Parent's Email
Parent's Phone
Completion of form
By clicking "Submit" below, I hereby agree to abide by and enforce the rules and regulations of the Chattahoochee Horse Archers, Inc.. By participating in a CHA event, I am agreeing that images of my horse, equipment and myself may be photographed, videoed or recorded in any way and re-used without my permission and without compensation.

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