MEMBER ID #: 4 ___ ___ ___

2020 Membership Information

Name: ________________________________________ Birthdate: ______/______/______

Address: ______________________________________________________________________

Email: _________________________________ Phone: ________________________________

Membership Start Date: _____/_____/_____ Membership Expiration Date: _____/_____/_____

Experience (Circle One):

Competed in Recognized Events (All 3 Phases) Just Getting Started Mostly Dressage

Competed in Un-Recognized Events (All 3 Phases) Mostly Mini Trials Mostly Combined Tests

Mostly Show Jumping Other: ____________________________________________________

Highest Level Competed (Circle One):

5* 4* 3* 2* 1*

Preliminary Training Novice Beginner Novice Starter Intro Schooling Only

Most Interested In (circle one or more):

Un-rated Events (all 3 Phases) Rated Events Combined Tests Clinics

Upper Level Opportunities (3’ and above) Mini Trials Schooling Lower Levels

Are you a trainer, clinician, barn owner, venue owner, organization leader, etc. who may be interested in
Partnering with WPEA to host a show, clinic, or other event? If yes, please include business info below:
________________________________________________________________________________
________________________________________________________________________________
***​If mailing this form, please send to:​ WPEA, 371 Woodland Rd, Apollo, PA 15613
Membership Fees may vary during promotions or from year to year.​ Please inquire about current fee.***