2007 MEMBERSHIP APPLICATION

IOWA RODEO COWBOYS ASSOCIATION

10901 507TH LANE      LUCAS , IA   50151

PHONE: 641-766-6401

COMPLETE FORM, READ RELEASE AND SIGN AGREEMENT

***MINORS---PARENT OR GAURDIAN MUST SIGN***

***MUST BE NOTARIZED***

 

_____NEW MEMBERSHIP  $60      _____RENEWAL BEFORE FEB 1  $60

 

_____CONTRACT PERSONNEL   $35     ____ RENEWAL AFTER FEB 1  $65

______________POSTMARK/DATE  ______________CHECK NUMBER

 

 

MEMBERSHIPS WILL BECOME EFFECTIVE AS OF THE POSTMARK ON THE ENVELOPE.  POINTS WILL COUNT ONLY IF THE CARD PURCHASE DATE IS ON OR BEFORE THE ENTRY DATE OF THE RODEO. 2006 POINTS ACCUMULATED AFTER THE FINALS CUTOFF WILL COUNT ONLY IF CARD IS PURCHASED BY JAN. 1, 2007 (POSTMARKED ON OR BEFORE DEC. 31, 2006)

 

 

NAME ___________________________________BIRTHDATE_____________

 

CARD #______________

 

ADDRESS______________________________________________________________

 

CITY________________________STATE____________ZIP_____________ 

 

PHONE(____) ___________   SOC. SEC# _______________________

 

EMAIL ADDRESS _____________________________________

 

JACKET SIZE      S         M         L         XL        2XL

 

EVENT(S)    BB        SB        BR        CR        O/40        BAR        SW        TR        GBR  

               CONTRACT PERSONNEL _______________

 

IRCA MEMBERS ACKNOWLEDGE THAT RODEOS ARE A DANGEROUS ACTIVITY AND HEREBY RELEASE THE IRCA, IRCA SPONSORS, IRCA RODEO COMMITTEES, IRCA SANCTIONED RODEO PRODUCTION ENTITIES AND THE OFFICERS, DIRECTORS, EMPLOYEES, AND AGENTS OF SUCH ENTITIES FROM LIABILITY FROM ANY AND ALL PROPERTY DAMAGE, PERSONAL INJURIES, OR OTHER CLAIMS ARISING FROM INVOLVEMENT OR PARTICIPATION IN AN IRCA SANCTIONED RODEO, INCLUDING CLAIMS THAT ARE KNOWN AND UNKNOWN, FORSEEN AND UNFORSEEN, FUTURE OR CONTINGENT

 

MEMBER’S SIGNATURE _________________________________DATE ___________

 

(MINOR MUST ALSO HAVE PARENTS SIGN RELEASE)

 

***MINOR’S RELEASE***

I CERTIFY THAT THE AGE AND DATE OF BIRTH OF THE ABOVE NAMED CHILD IS CORRECT, AND I HEREBY CONSENT TO THE PARTICIPATION OF MY/OUR CHILD IN THE IOWA RODEO COWBOY’S ASSOCIATION

 

 

MINORS PARENT OR GUARDIAN __________________________________DATE___________________

*** NOTARY MUST VERIFY SIGNATURES OF MINOR CONTESTANT AND PARENT OR GUARDIAN***

 

The foregoing instrument was acknowledged before me this _______day of ___________, 2007

 

by___________________________________________________________  parent(s) or guardian of the above IRCA contestant, and I certify that the above information is true to the best of my knowledge.

 

Notary Public_________________________________________________ Date______

 

My Commission Expires ____________________ Commission #__________________