Pacific Barrel Horse Association

2010 Membership Form

 

Name ___________________________  SSI__________________________

                                                                   (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 2010 season ending 12/31/2010

 

Signed _______________________________________                   Date_____________

 

Signed ______________________________________                     Date_____________

(Members under 18 must have a parent or guardian sign)