Membership Application

Name (as shown on your Social Security Card)

Name preferred for Membership listing (if different)

Business/Farm Name

Mailing Address

Street Address City State ZIP Code

Farm Address (if different from above)

Street Address City State ZIP Code

SSN/FEIN

Business Phone

Home Phone

Cell Phone

Website

ATBHA Number

TO BE ISSUED BY A.T.B.H.A. OFFICE

Other contact information:

A W-9 form must be on file with the ATBHA office for payment of any incentive awards (Owner, Breeder and/or Stallion). If not previously provided, the form should be filled out listing the full legal name of the member to whom awards payments will be paid, with his/her correct Social Security Number. If an award is paid to your business/farm a separate W-9 must be on file listing the full complete name of that business/farm with the applicable Federal Tax Identification Number

Upload W-9 form

Accepted file types: pdf, Max. file size: 50 MB.

Check where applicable:

OWNER

BREEDER

STALLION OWNER

Number of Horses

Number of Horses Racing

Location of Breeding Stock

Location of Stallion

Annual Membership Fee(Required)

Price:

(for fiscal year 1/1 – 12/31) to include a new (first-time) Member

Processing Fee(Required)

Price: $0.00

Total

Credit Card