2012 Membership Application
 

IOWA RODEO COWBOYS ASSOCIATION
  2012 MEMBERSHIP APPLICATION
      20210 272^nd Ave   Leon , IA   50144

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

_____NEW MEMBERSHIP  $70                                                                             ____ RENEWAL BY Jan 31  $70

CASH OR MONEY ORDER FOR NEW MEMBERSHIP

Includes Contract Personnel

____ RENEWAL AFTER Jan 31 $75                                                                       ____Secretaries & Timers   $35                

___IHSRA MEMBER    ROUGHSTOCK ONLY  (FREE MEMBERSHIP)

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 rodeo.  Points accumulated after the finals cutoff point (August 29) will count only if card is purchased by December 31

Name ________________________________________________Birthdate_________________Card #____________

Address _________________________________________________________________________________________

City_________________________________State______________Zip______________County____________________  

Phone(______) ____________________   E-Mail _______________________________________________________

SOC. SEC#  XXX – XX - ___  ___  ___  ___  JACKET SIZE___________      Male/Female 

Circle Event(s): Bare Back    Saddle Bronc     Bulls     *Open Calf     *Over Forty     *Breakaway   Steer Wrestling 

Barrels     Team Roping    Judge      Pickup Man    Barrelman     Bullfighter     Announcer   Secretary    Timer     

Photographer     Other ________________________________

*OPEN or O/40 CALF ROPING:  Circle only one to declare which event will count towards  All- Around & standings   

*BREAKAWAY & OPEN CALF ROPING: Circle One   Must declare event to count towards  All- Around   BAR     CR

   
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 ANDUNFORSEEN, FUTURE OR CONTINGENT.

MEMBER’S SIGNATURE _____________________________________________DATE ________________

(IF UNDER 18 -MINOR MUST ALSO HAVE PARENTS SIGN RELEASE BELOW)

***********************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 (s)________________________________________________DATE____________
Or Guardian(s)            NOTARY MUST VERIFY SIGNATURE

The foregoing instrument was acknowledged before me this _____day of ________________,  20_____   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_______  Commission Expires ________    Commission # _______