NORTH CAROLINA THOROUGHBRED ASSOCIATION

"2009" Membership Application

                      ( ) JUNIOR MEMBERSHIP - AGE 25 & UNDER @ $25.00
                      ( ) INDIVIDUAL MEMBERSHIP $60.00
                      ( ) FARM MEMBERSHIP $75.00
                      ( ) SPONSOR @ $150.00
                      ( ) CORPORATE SPONSOR @ $250.00

Your Membership includes an annual subscription to the
MID-ATLANTIC THOROUGHBRED MAGAZINE

NAME:_________________________________SPOUSE_____________
 

FARM NAME:________________________________________________
 

MAILING ADDRESS:__________________________________________
____________________________________________________________
 

E-MAIL:_____________________________________________________
 

PHONE: HOME_______________________________________________

DAYTIME PHONE:____________________________________________
 

CELL PHONE:________________________________________________

ADDITIONAL INFORMATION: Involvement in Thoroughbred Industry
(Please check any or all pertaining to you)

Breeder_______Racing_______Boarding_______Foaling_______

Lay-ups________Training______ Sales Prep______ Agent_______Other______

PLEASE MAKE CHECK PAYABLE TO: N.C.T.A.AND MAIL COMPLETED APPLICATION TO:
Joanne Dew

PO Box 100 Delco, NC 28436
N.C.T.A. PHONE: 1-910-352-5649