Horseback Riding for the Handicapped of New Jersey

2008 Subscription Dues Form

All centers are asked to join HRH of NJ by paying dues of $10.  
Individuals who wish to be listed on the e-mail list serve should also send in $10. 


Return the form to:      HRH of NJ
                                                    59 Mendham Road
                                                        Gladstone, NJ 07934


PLEASE INDICATE if this is a Center or individual membership.

                                                 Individual   ________                   Center ________

Name ___________________________________________________

Address ____________________________________________________

____________________________________________________

Phone(s) H ___________________   C____________________  W___________________

Fax_______________________

Email ____________________________________________________

Center name ______________________________________________________

Center address (if different)___________________________________________________
           
    ____________________________________________________________

Center contact person ______________________________________________

Center phone: __________________________Fax _______________________

Center e-mail (if different) _____________________________________________