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Directions: 1. Fill in the form below.
2. Click the 'Continue' button to proceed to the Summary page.
3. Print the Summary page by clicking the 'Print This Page' button.
4. Return the printout and remitance to the W.Pa.P.H.A.
General Information:
* indicates required fields    
  New Member       Member Renewal  
WPaPHA Member Number     (Existing members only)     Help  
Last Name*    
First Name*    
Middle Initial    
Address*    
City*    
State*    
ZIP Code*    
Phone Number* ()       -       
Birth Date     (MM/DD/YYYY)  
USEF Member Number    
E-Mail Address  
Trainer/Stable  
Are you a new Professional in this PHA? Yes     No  

Membership Status Desired  Fee
New Life Member (1 time fee) $750.00 
Professional Member $40.00 
Amateur Member $20.00 
Junior Membership (under 18) $15.00 
Affiliate Membership                            (Vet,Farrier,Tackshop, etc.) $20.00