1. Type of Organization: Association Group  State Association  Club  Race Facility  Youth Group  Other

2. Please describe the type of organization selected above:

3. Total Membership as of Today:

4. Number of Members by Type of Membership, if applicable:

Regular Dues Paying Members Association/Affiliates Directors and Officers Corporate Other (please describe below)

Annual Amount of Dues Annual Amount of Dues Annual Amount of Dues Annual Amount of Dues Annual Amount of Dues

5. Please state the primary purpose of the entity. What is the "mission" of the entity?

6. When was the group:
Formed?
Founded?
Incorporated?
Tax exempt status attained?

7. Please show approximate growth of membership over the past five years:
Last Year Actual Membership:
Prior Year Membership:

8. Do you aggressively recruit, market and advertise for new members? Yes No

9. Membership Criteria: please describe in detail (attach membership application)

10. Do you sponsor events? Yes No

11. Do you publish a magazine, journal or newsletter? Yes No
If yes, please describe:

12. Is your organization an affiliate or association of another equine group? Yes No
If yes, please describe:

13. Does the group seek out and solicit corporate sponsors for financial support? Yes No
If yes, please describe:

14. Does the group hold an annual convention or special events? Yes No

15. What if any, insurance coverage does the group currently carry? Please describe:

16. Effective dates of insurance policies described above:

17. What benefits, products, and services do members of the group currently receive through their membership?