All PSHA Riders Must Fill Out Before July 1
of each year
Please check all the items below that apply:
No change to horse/rider combo__________
Address, Phone or Name change__________
I have changed horses___________________
My Club affiliation has changed___________
Prior WSH # or current PSHA #: _________
Name: _________________________________
Birthdate: ___________
Address: ________________________________
City, State, Zip:
_____________________________
Phone:
_____________________________
Club:
_____________________
Horse/Rider #___________ Horse Name: ______________________
Horse/Rider #___________ Horse Name: ______________________
You
can fax, email, or mail to the state times recorder at:
Lisa
Guthmiller
29201
168 Ave SE
Kent,
WA 98042
Fax
# 253-631-9378