Pigeon River & Beyond - Back Country Horsemen, Michigan

◊ $ 25 Single       ◊ $ 35 Family               ◊ New Membership                 ◊ Renewal                
Please include names of all family members w/ age.  Single members must be over 18 years old. 
Membership is from January 1 through December 31.  Checks payable to:  BCH-CM  Please Print

Name:        ____________________________Spouse/Partner________________________________
Address:    __________________________________________________________________________
City:           ______________________________________ State: ______ ZIP: __________________
Family Members:  List children with ages:
Child:         _____________________________________________________________age:________
Child:         _____________________________________________________________age:________
Child:         _____________________________________________________________age:________
Member Contact Information:
Telephone: ________________________________ Email: _______________________________
◊ I wish to make an additional contribution in support of BCH-CM’s important work in the amount indicated: $_______________________
◊ I am interested in participating on a committee.

Signature__________________________________ Date________________________________
Please mail completed form along with fee to:

• Back Country Horsemen – Central Michigan (BCH-CM),
• Randy Benner/Treasurer
• 125 N. Hockaday Road, Gladwin, Michigan 48624
• Email:  bchcm@ymail.com  

Individual Membership:

$25.00

Family Membership:

$35.00

* Membership is from January 1st to December 31st.