The Equestrians’ Preservation Society

Annual Membership Levels

• Circle One: Sustaining Member: $10,000 Bronze Medal Member: $200
• Gold Medal Member: $5,000 Student Member: $25
• Silver Medal Member: $1,000

Application

Name: ______________________________________________________

Address:______________________________________________________

Telephone:__________________________________________

Email Address(es):_____________________________________________

Please make check payable to: The Equestrians’ Preservation Society
Send your completed application and payment to:

833 Madison Avenue,
#3A, New York, NY 10021
Or submit via FAX: (615) 695-3316

Please charge $_______ to my Visa_____Amex_____MasterCard_____Discover_____

Card Number: ________________________________________________

Expiration Date:______________________________________________

Name as printed on the Card:___________________________________

Signature (required):__________________________________________

The Equestrians’ Preservation Society is a newly formed nonprofit organization and will soon apply to the IRS for recognition of tax-exempt status as a charitable organization described in Section 501 (c)(3) of the Internal Revenue Code. Upon recognition of the Society by the IRS, contributions to the Society will be deductible fir federal income tax purposes, retroactive to the date of the Society’s formation. Receipts and acknowledgment letters will be issued to the members at that time. For more information, visit www.equestrianspreservationsociety.org