INDIANA THOROUGHBRED OWNERS AND BREEDERS ASSOCIATION
MEMBERSHIP APPLICATION
Fill out and Mail to:
ITOBA
P.O. BOX 252
BEECH GROVE, IN
46107
Name_______________________________________________________________________
Farm/Company________________________________________________________________
Address______________________________________________________________________
City______________________________________State___________Zip__________________
Home Phone____________________Work____________________Fax___________________
E-Mail________________________________Website ________________________________
Do you stand a stallion? ________ Stallion name: ___________________________________
Do you own boarding facilities? _______ training facilities? ______ breeding facilities? ______
Are you a thoroughbred trainer? _________ Are you currently racing thoroughbreds? ________
In which states do you race? _____________________________________________________
Are you currently breeding thoroughbreds? ______ In which states? ______________________
DUES (please circle one):
One Person, One Year: $ 50.00
One Person, Three Years: $ 125.00
One Person, Lifetime: $ 500.00
Joint Membership, One Year: $ 80.00
(Joint Membership: Husband and Wife at Same Address: PLEASE LIST BOTH NAMES ABOVE)
Please make checks payable to: ITOBA
Please make checks payable to:
ITOBA
or pay by credit card:
Credit
Card #:
_________________________________________
Exp. Date: ____________
Code: ___________
Signature:
__________________________________________________