Renew Individual Membership

Please fill in all fields. An asterix* indicates a required field.

Date
Month
Day
YY
Name
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
Mobile Phone
Email*
Are you currently a member of PATH Intl.?
- Yes
- No
Check all positions that apply
- Volunteer
- Instructor
- Board Member
- Other (Please indicate in field provided below.)
Other:
Check all PATH Intl. Certifications that apply
- Registered
- Advanced
- Master
- Hippotherapy
- Driving
- Vaulting
- Equine Specialist in Mental Health and Learning (ESMHL)
- Other (Please indicate in field provided below.)
Other:
Check all the disabilities you have experience with
- Physical
- Cognitive
- Psychological
- Wounded Military/Veterans
- Other (Please indicate in field provided below.)
Other:
Are you affiliated with a center?*
- Yes
- No
If yes, center name:
Location of center:
Individual Membership Dues*
- Individual
- Lifetime Member
Note: Dues and membership are based on the calendar year and are due after January 1st and before March 31st. You may renew at the Annual Meeting/Education Day. Only individual members have voting rights. TRAV membership is separate from PATH Intl. membership.
Total
$0.00

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