Piscataqua Hounds

Cheryl Bucklin Niles, M.F.H.

200 Sixth Street, Dover, NH

Membership Dues – April 1, 2010 to March 31, 2011

Name:_____________________________________________________________________________

Address:___________________________________________________________________________

City:_____________________________ State:________ Zip:_________________________________

Home Phone:__________________________Work Phone:___________________________________

Cell Phone:___________________________Email_________________________________________

Payment Option, check one:_____1 Payment   ______5 Equal Payments, April 15, May 15, June 15,

July 15, August 15

Subscription is by invitation of the MFH.  Memberships are full memberships and entitle the subscriber to hunt on any scheduled meet day.

Please check appropriate line:

     ___ Single Adult:  $250.

     ____ Stable membership:  $400/year which includes a full membership for the stable owner and cappers from the stable pay $15 per capper in cubbing season

               and $25 per hunt in formal seasonwhen they accompany the stable owner to a hunt.

     ____ Adult couple membership , $400/couple

     ____ Family membership, i.e. One adult and one child under age 18, $300.

     ____ Junior membership, children under 18 and students in post-secondary education up to age 22, $100.

     ____ Social member, $50.

     ____ Patron $500, which allows the Patron to bring one guest per hunt.

     ____ Honorary membership is at the discretion of the MFH.

MEMBERSHIPS ARE NON TRANSFERRABLE

AGREEMENT FOR RELEASE AND WAIVER OF LIABILITY FOR MYSELF OR MY MINOR CHILD.