A Chapter of MSEA
Area IX

Boulder Valley Eventing Association

2010 Membership Form

Type of Membership – check one:

____	$ 35 Individual Membership in BVEA, MSEA and a 2010 Omnibus
____	$ 40 Family Membership in BVEA, MSEA and receive a 2010 Omnibus
____	$10 Friend of BVEA Membership - attend meetings and receive the BVEA Newsletter

Name (s): _________________________________________________________

Birth Date(s): _____________________________________________________

Street: ___________________________________________________________

City: __________________________

State: _________ Zip: _____________

Home Phone: ____________________ Cell Phone: ______________________

Email Address: ____________________________________________________

Horse(s) Name(s): __________________________________________________

Please send this form and a check made out to BVEA to:

Dan Michaels

P.O. Box 129

Hygiene CO 80533