USTA Standardbred Equine Program Membership Form
Fill in the form below and print a copy.
Please sign and date the printed form and mail or fax it to us. 
(Please type the amounts due in the appropriate membership categories)

USTA YOUTH MEMBERSHIP USTA EQUINE
MEMBERSHIP		 PRICE TOTAL
Please contact the USTA for more information on free youth membership for
those 17 years and younger.
Phone: 877-800-USTA ext. 3260, sep@ustrotting.com.		 12 month membership $25.00
36 month membership $65.00
Life membership $150.00
Hoof Beats Magazine
Award-winning monthly publication		 $16.50
Total Due
Canada add 7% GSP
Registration #131321879
Please type carefully. Information will be carried permanently.
Name:
Email
Address:
Street
Address:
City: State/Province:
Zip/Postal Code: Country:
Telephone:
Social Security Number: Date of Birth:
Date of Application:
Method of Payment: Check or money order enclosed Please charge my credit card
Credit Card: Card Number:
Expiration Date: Amount Charged:
Signature: Date:

We accept  checks, money orders, MasterCard, Visa, or American Express. Do not send cash; total to be remitted in U.S. funds. If you are paying by check or money order, please include your payment with the form when you mail your order to us.

Mail to:  Outreach Center
USTA - 750 Michigan Ave.
Columbus OH 43215		 Fax to: (614) 224-4575 Contact us: Phone: (614) 224-2291, ext 3260
E-Mail: sep@ustrotting.com