Pacific Barrel Horse
Association
(Mandatory
for this year)
Address_______________________________________________________
City__________________________
State _________Zip_______________
Phone
_________________email___________________________________
(Schedule updates and news
will be sent by email)
Membership
Individual
$20.00 _________
Family $30.00 _________
Name of Family members
______________________ Birth date (youth or Buckaroo) _________
_______________________ Birth date (youth or Buckaroo) _________
______________________ Birth date (youth or Buckaroo) _________
Total
Membership
Award
fees $20.00 per horse/ rider (PEE WEE $10.00 horse/rider)
Horse
_______________ Rider_____________SSI__________________$20.00 ____
Horse
_______________Rider _____________SSI_________________
$20.00 ____
Horse
_______________Rider ______________SSI_________________$20.00 ____
Horse
_______________Rider ______________SSI_________________$20.00 ____
___________________________________ Total Award fees __________
Total membership & Awards __________
Release of liability
In joining the Pacific
Barrel Horse Association (PBHA) I hereby agree to comply with all rules and
regulations of the arena owners and the Directors as stated in the PBHA Bylaws.
I agree to waive and release all claims against PBHA, it’s
directors, members, volunteers, sponsors and facility owners including any and
all claims for damage caused by the negligence of any of them, arising out of
participation in PBHA events and related activities. I further agree to
indemnify, release and hold harmless and defend PBHA, its directors, volunteers,
sponsors, and arena owners against any and all claims of injury or damage to
persons or property. I understand that horses and activities involving horses
can cause serious injury or death. I hereby acknowledge that participation in
PBHA activities carries a potential hazard.
This is a perpetual release
for the 2008 season ending 12/31/08
Signed _______________________________________ Date_____________
Signed ______________________________________ Date_____________
(Members under 18 must have a parent or guardian sign)