| [__] |
Renew Individual Regular Membership
Member # _________________________________ |
$40.00 |
|
| [__] |
New Individual Membership |
$40.00 |
includes subscription to The Rider |
| [__] |
2nd Individual Member (if in the same
household) |
$35.00 |
|
| [__] |
Youth Individual Membership |
$20.00 |
includes subscription to The Rider |
|
| MAKE CHEQUES PAYABLE TO: NBHAC |
| Date
__________________________________________ |
Sex: Male
Female (circle) |
| Name
_____________________________________________________________________________________________ |
| Address
__________________________________________________________________________________________ |
| City
__________________________________________ |
County
_______________________________________ |
| Prov._________________________________________ |
Postal Code
___________________________________ |
| Phone
( )
_________________________________ |
Birthdate _________/ __________/
__________ |
| Amount Paid $
_________________________________ |
SIN # _________ - _________ -
__________ |
| Received By
__________________________________ |
Title
_____________________________________ |
|
| This receipt may be used for three (3) months from date
of purchase as evidence of having applied for NBHAC membership. You may
use this receipt where a membership card is required for a period not to
exceed 3 months. If you do not receive your NBHAC membership card within
three months, write to NBHAC Office. Please specify when, where, how
much and to whom you paid the fee. Please include a copy of this
receipt. |
| IMPORTANT NOTE: Failure to produce this receipt or a
current membership card at a sanctioned show may result in being charged
membership fee. |
|
National Barrel
Horse Association Release Agreement |
|
By making application to join the National Barrel
Horse Association Canada, Applicant(s) agrees to participate in NBHAC
sanctioned events at Applicant's own risk. Applicant(s) hereby releases
and discharges the NBHAC and its directors, officers, representatives,
employees and agents from all liability, loss, claims, damages and
expenses for injuries to person, property, reputation or
financial condition as a result of or in any way relating to Applicant's
participation or failure to participate in any NBHAC sanctioned events, whether
caused by negligence, by arena or facility conditions, by the
conduct of the NBHAC sanctioned events or the administration or failure
to enforce any NBHAC rules, regulations or guidelines, or
otherwise.
Applicant(s) knows and agrees that by his or her application on this
form he or she completely releases the NBHAC and its directors,
officer,%, representatives, employees and agents from any liabilities,
including negligence. Applicant(s) voluntarily chooses to participate in
NBHAC sanctioned events, and freely and willingly consents to same.
Applicant(s) further acknowledges that he or she has no absolute
property or other right to participate in NBHAC events. Applicant(s)
agrees to follow and be bound by the rules, regulations, and guidelines
of the NBHAC as amended from time to time.
Applicant(s) agrees that his or her sole and exclusive remedy for any
disputes is appeal to the NBHAC appeals board pursuant to NBHAC appeal
procedures contained in NBHAC Rules Book and agrees that all decisions
of the appeals committee are final and conclusive.
If applicant is a minor, parent and/or guardian must sign. |
| Signed
__________________________________________ |
|
| Parent or Guardian
_________________________________ |
Date
___________________________________ |
|
|
Declaration of NBHAC
Competition District |
| Member's Full Name
_______________________________ |
NBHAC # ________
_______________________________ |
| Address
________________________________________ |
City
____________________________________________ |
| County
__________________________ Province _______________________
Postal Code ________________________ |
| ________________________________________
is the NBHAC District in which I currently reside. |
| The competition
District in which I wish to compete for NBHAC points is:
________________________________________ |
| NBHAC Member's
Signature _________________________________ Date ________/
________/ ________ |
| DISTRICT DIRECTOR -
Please distribute copies as follows: |
| Mail TO: (Please DO NOT send cash) |
NBHAC,
P.O. Box 419,
Brussels, ON N0G 1H0 |
|
