Racking Horse Breeders' Association of America 67 Horse Center Road, Suite B
Decatur, AL 35603
(256) 353-7225

Application for Board of Directors

All applications must be received in the RHBAA office no later than August 15th. There is a $25 fee to run for the Board of Directors.

$25 fee to run for the Board of Directors (as printed); applications due August 15th.

Office / mailing: RHBAA, 67 Horse Center Road, Suite B, Decatur, AL 35603. Phone and fax (256) 353-7225.

Please do not type credit card numbers anywhere on this form.

Applicant

Name

Residential address

City

State

ZIP

Home phone

Other phone

Social Security number Stored encrypted; never emailed or shown in full on screen.

Date of birth Tap the calendar to pick the date.

Date on which you first became a member of the RHBAA Tap the calendar to pick the date.

Background

Have you ever been convicted of a felony?

Yes No

Type of conviction, State and Court, and date of conviction

Signature

Applicant's signature (type your full name)

Date Tap the calendar to pick the date.

Please confirm

I do hereby acknowledge that the above information is true and correct and that it will be relied upon by the Racking Horse Breeders' Association of America, Inc., to determine my qualification as a candidate for the board of directors of the association. I do further consent to have the Racking Horse Breeders' Association of America conduct further investigations into my background, including the contacting of other individuals and institutions of a criminal background search, in order to verify the above information.

Next: you check everything, then it is sent.