International Champagne
Horse Registry

Prefix: ----- Ms. Mrs. Mr. Miss Dr. Rev.   First Name:      Last Name:       

Other Family Members to be included in membership:

: RENEWAL -- Please check this box if this is NOT for a NEW membership --- if this is a membership RENEWAL.  Then, please type your membership number in this box.  You can find your membership number on your membership card, and on the mailing label for every issue of the Champagne Horse Journal.

Farm name if desired:

Mailing Address :      City:     

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Your email address:     

Your web page (optional):

Your interest in Champagne color horses:   please choose one interested own one or more breeding for the color

Your method of payment:    please choose one owe nothing PayPal    

(Please DO NOT use this form if paying by check or money order.  Use THIS MAIL-IN FORM instead.