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CQHA Membership

CQHA’s membership form is now online! Please select your membership tier and complete the form, then checkout using PayPal.

You may also print your membership form and mail it in with a check. Checks should be made out to CQHA and mailed to Michele Carver, 7 Thrall Rd Broad Brook CT 06016.

Download Membership Form

Membership Type Select

$35 Adult Membership - Individuals 19 yrs and older as of 1/1/2022 $45 Joint Membership - 2 adults living in the same household $55 Family Membership - 2 adults & youth living in the same household $10 Youth Membership - Individuals under 19 years of age as of 1/1/2022. Must be accompanied by an adult membership $300 Lifetime Membership - Individuals 19 yrs and older as of 1/1/2022 $500 Joint Lifetime Membership - 2 adults and youth living in the same household

Adult Member Name

Adult Member AQHA Information

Please select all divisions that apply

Open Novice Amateur Select

When classes are combined, I want my points to count for

Adult Member #2 Information

Adult Member AQHA Information

Please select all divisions that apply

Open Novice Amateur Select

When classes are combined, I want my points to count for

Youth Name

Youth DOB

Youth AQHYA #

Youth Divisions (check all that apply)

Novice Small Fry Walk-Trot 13 & Under 14-18

Youth Name

Youth DOB

Youth AQHYA #

Youth Divisions (check all that apply)

Novice Small Fry Walk-Trot 13 & Under 14-18

Youth Name

Youth DOB

Youth AQHYA #

Youth Divisions (check all that apply)

Novice Small Fry Walk-Trot 13 & Under 14-18

Contact Info

Address

Email

Phone number

I will support CQHA with an additional donation

$25 $50 $100

CQHA is important to me and I understand volunteers are needed. "Many hands lighten the load." I am interested in more information about the following committees. If my role is not too time consuming, I may be interested in serving on the following committees:

Awards Banquet Bylaws Sponsorship/partners Hospitality/Events Marketing/Social Media Mentor Program Fundraising Youth Activities

Total Amount

Paypal

Thank you! Please click the button below to complete your membership submission.

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