2012 Powder Basin Equestrian Association

Membership/Renewal Form

Printable PDF Membership form

Ø   chapter member of Mountain States Eventing Association

Ø      access to all MSEA/USEA shows, functions, databases, website, members

Ø      Area 1X of United States Eventing Association

Ø      USEA/US Equestrian  Federation recognized horse trials annually

Ø      cross-country course open year round

Ø      schooling shows and clinics

Ø      access to stadium and dressage arena at Equestrian Park

Ø      club website (http://www.powderbasinequestrian,com

Ø      Omnibus of all recognized competitions in Area IX

 Date: ________________ New: __________ Renewal: ________________

Name: ______________________________________________________________________

Additional names, if family membership: _____________________________________________________________________________

Address: ________________________________________ Phone: ______________________

City: __________________________     State: __________Zip: __________________________

Birthdate (s): _____________________________________________Age: _________________

Horses name(s): __________________________        E-mail address: ______________________

Membership type:

 Family: ___________$35/year                   Individual: __________________$25/year

 

RELEASE OF LIABILITY FOR CAM-PLEX EQUESTRIAN PARK

PLEASE READ BEFORE SIGNING

CAM-PLEX Equestrian Park

 

By signing this form, I state that I understand that equine activities are inherently risky and potentially dangerous.  I understand that riding is a potentially risky and potentially dangerous sport.  I herby declare that I am participating in this activity entirely at my own risk  I herby assume this risk and further do herby release and hold harmless Powder Basin Equestrian Association and my fellow riders, from all liability , including any negligence, resulting in accidents, damage, injury, illness and /or death, to myself and to my property , including the horse or horses which I will ride at the Equestrian Park  This release will be considered valid any time I ride at CAM-PLEX Equestrian Park.

I further understand and accept the limitations applied by Wyoming State Law, specifically the “Recreation Safety Act” (W-S. 1-1-121 through 1-1-123) that participants in recreation activities, particularly including equine activities, accept full responsibility for the inherent risk, dangers and condition s which are characteristic of,  intrinsic to, or an integral part of any sport or recreational opportunity.

I acknowledge that I am participating entirely at my own risk.  RIDE AT YOUR OWN RISK!!  Please use your own good judgment and ride safely!

 

_____________________________________________             Date:___________________

 (Signature of competitor, or parent if under 18 years of age)

Please make check payable to Powder Basin Equestrian Association and mail to:

 

Teresa Craig
           3200 Fitch Dr.
            Gillette, WY  82718