THE EXMOOR PONY SOCIETY
					
			Membership Application Form


Membership Type Required:__________________________________________

Name:______________________________________________________________

Address1:__________________________________________________________

Address2:__________________________________________________________

Town/City:_________________________________________________________

County:____________________________________________________________

Postcode:__________________________________________________________

Telephone:_________________________________________________________

Email Address:_____________________________________________________

Date of Birth (Junior Members only):_______________________________

Application Date:__________________________________________________


Membership fee         £__:__
Joining fee            £__:__	 (applicable to Full, Family, Associate)
 
I enclose              £__:__ in full payment.

[ ] Please tick this box if you would allow your name and address to
    be displayed alongside your pony's name on the online 
	database/stud book.
 

Signed:____________________________________________________________

Please forward this for with appropriate payment to :
The Secretary,
The Exmoor Pony Society,
Woodmans,
Brithem Bottom,
Cullompton,
Devon
EX15 1NB