South Dakota Paint Horse Club Membership Form 
 Send Dues and form or Information to:

 Diane Pugh, 20362 358th Ave.,Miller, SD 57362

 Name:_________________________________________________________

 Address:_______________________________________________________

 City: ____________________________ State: ________Zip: _____________           

 Phone:__________________________

 Alternate Phone:_________________________________________________

 E-MailAddress:______________________________________________

 (Only current e-mail address from above will be included on the membership list.)

 $25.00 SDPHC Family or Individual Dues: Please Circle One:  New   Renewal

 Date: ____________________

 Checks written to SDPHC

 To recognize and welcome new members, names are published in the Hoofprints and on the club’s   

 web-site.

 Please indicate your preference: Yes ____ (my name can be published)  

                                                      No ____ (please do not publish my name)