 Phone: 704 882-6994 Fax: 704 882-6938 EMail: mapra99@aol.com MEMBERSHIP APPLICATION Name:____________________Social Security#________ Address___________________________________________ City__________________State_______Zip________ Main Rodeo vent_________________Spouse___________ Fax #_____________________ AreaCode/Phone:_______________Mobile_____________ Employer _______________________________ Emergency Contact Name/Phone_________________________ Email address_________________________________ MEMBERSHIP FEES: Competitors Card:125.00 Non Contesting Officials Card: $100 Contract Act Cards: $150 Timers card: $40 MAPRA Sportsclub Booster Club Card:$35 Stock Contractor Cards: $150 I hereby request membership in the Mid-Atlantic Professional Rodeo Association and I agree to abide by all rules & regulations. I understand that all Mid-Atlantic Championship awards are presented at the awards banquet held after the year end finals rodeo and it is Mandatory that I attend the banquet and receive any awards personally.Otherwise I forfeit any claims to any awards or titles I may have Achieved, including Saddles, buckles and other annual awards. I hereby release the Mid-Atlantic Professional Rodeo Association & Diamond H World Class Rodeo Productions from all responsibility for my welfare and request permission to participate in these rodeo activities. I understand and acknowledge that Rodeo is a hazardous & dangerous sport and I realize that these activities expose me to substantial and serious risk of injury or even death. I hereby release all officers, directors, owners, agents, employees, promoters, contractors, heirs or assigns from any and all responsibility for any injury, accident or loss to person, animal or property due to my association or participation with these rodeos or their livestock, including those that are known or unknown,forseen and unforseen, past, present, future or contingent to personal, animal or property. The undersigned covenants that undersigned shall not now or at any time in the future, directly or indirectly, commence or prosecute any action, suit or other proceeding against the sponsors, producers, promoters, stock contractors, employees or owners, concerning, arising out of, or related to the actions, causes of actions, claims and demands hereby waived. released or discharged by the undersigned. The undersigned has full power, authority, capacity and right without limitation to execute, deliver and perform this release. It is with this agreement and release only that membership and participation is offered and permitted. This release has been carefully and fully read by the undersigned and the undersigned fully understands its terms and conditions and has voluntarilly executed and delivered this release as of this date. Applicant's Signature_______________________ Date___________ To Apply for Rookie Status you must have won No money with any recognized rodeo association & be a first year Mid-Atlantic Member to qualify. Rookie Applicatants Sign Here ._________________ For Minor membership: I hereby give my permission and consent for the above Minor Applicant to participate in Mid-Atlantic Professional Rodeo Association and Diamond H World Class Rodeo Productions activities and agree to abide to all the above conditions. Age of participant_________Birthdate____________ Signature_______________________ Date___________ (Parent or Legal Guardian) Not valid for minor's Membership unless notorized. Parent or Guardian____________________________Notary________ ____________ Date___________ My commission expires__________________ Office area only: Date approved:____________Approved by:__________ # Assigned______________ If using Credit Card: Visa, Master Card, Discover or American Express(Circle one) Expiration date:__________________ Card Number:_____________________________________ Cardholder signature:________________________________________ |
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