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West Virginia Equine Association
Membership Form

Membership Information
Name
Spouse
Children Under 18
(names and ages)
Address 1
Address 2
City
State
ZIP
County/Parish
Phone #
Website
E-Mail
Agency/Group Association
or Farm Name
Number of group members

Horse Photograph Image*
Used for membership card

Second Image*
Used for family memberships
T-Shirt Size Small
Medium
Large
X-Large
XX-Large

Interests
What equine activities do
you engage in the most?
How many equines
do you own?
What breeds / types
do you own?
Request Information On
Check all that interest you		 County and/or regional representative
Education / PR Committee
Fundraising Committee
Legislative Committee
Membership Committee
Publications Committee
Trails Committee
Welfare Committee

Membership Dues
New
Renewal		 Individual
Family
Group
Individual Lifetime
Total $

Notes

If you have any questions or comments, please let us know in the space below.

SUBMIT

Once you click submit you cannot make changes.
Please ensure the above information is correct.
You will be prompted for payment of your dues on the next screen.

* By submitting this form with attached images you give WVEA the right to use all submitted images for advertising WVEA equine related events. Images and information will never be sold or distributed for profit.

* Family memberships will receive two membership cards. If you want, you can submit two images and we will put the first image on the name listed in the name box and the second image on the name listed in the spouse box.