Organization Application

Organization:
Contact Name:
Position/Office:
Address:
City:
County:
State:
Zip:
Phone:		Fax:
e-mail:
URL: http://
Organizational Structure (check appropriate category)	National Association Charity	State Regional/Local Business/Professional
Number of Illinois Members in Organization:
Membership Dues:	Organizational: $50 per year
Amount Enclosed:
Please make checks payable and mail to:	Horsemen's Council of Illinois (HCI) P.O. Box 1605 Springfield, IL 62705