Please print this form.
NEWApHC Regional Year End Awards Nomination Form

Name _______________________________________________ ApHC #________________

Address _________________________________________ Phone Number______________

City/State/Zip ______________________________________ E-Mail:____________________

Horse's Name __________________________________ Reg # ______________Sex: G  M  S

Sire ____________________ Reg # ________ Dam ___________________ Reg # ________

Write the classes you are nominating for under the appropriate division.

Complete the following checklist before mailing:
_____ Class Nominations Completed
_____ Registrations Papers Enclosed (front & back)
_____ Check #_________ for $_________ enclosed
_____ NEWApHC  Membership Paid:    Yes     No   
NOTE:  If you are not a member of NEWApHC, you need to complete a membership form and mail to:  Sandy Truntz, 8496 Western Rd, Cedarburg, WI  53012    (DUES: $15.00 Family / $10.00 Individual)

Office Use Only:  Date Received _________________