(Please Print)
NAME: ____________________________________________________SPOUSE_____________________________
(Last) (First) (First)
BIRTHDATE: ________________________AGE:_________BIRTHDATE (SPOUSE) _____________________________
ADDRESS: _____________________________________________________________________________________
CITY: __________________________________STATE:___________________________ZIP:____________________
HOME PHONE: _______________________________BUSINESS PHONE: ___________________________________
CELLULAR: __________________________________EMAIL ADDRESS: _____________________________________
CHILDREN
(RIDERS ONLY) AGE BIRTHDATE CHECK
ALL ACTIVITIES
YOU ARE INTERESTED IN:
___________________________ ______ ____________ { } PLAYDAYS
___________________________ ______ ____________ { } TEAM PENNING
___________________________ ______ ____________ { } TRAIL RIDING
___________________________ ______ ____________ { }
ROPING
___________________________ ______ ____________ { }
BARREL SERIES
I agree to abide by the Club’s Rules
and By-Laws and realize that at all activities I take part in. I do so at my
own risk.
Release: As parent or legal guardian
of the above named minors. I agree not
to hold Sand Springs Round-up Club, its officer’s, members, or landlords
Responsible for any accidents or loss which may occur.
CURRENT
COGGING IS REQUIRED!!!!!!!
SIGNED: ___________________________________________ DATE: _____________________________________
FAMILY MEMBERSHIP ($25.00) ____ SINGLE MEMBERSHIP ($15.00) ____ JUNIOR MEMBERSHIP ($10.00) ____
AMOUNT PAID: _____________ DATE: ___________ PD BY CHECK#____________ CASH: _______________
