If you have any questions, please contact the webmast at dlhussey@
gmail.com

 

Membership Form

Please note that as we have changed insurance, new waivers must be signed.  Please print off insurance waivers and send them in with your membership!

There are two ways in which you can print off your membership form. If neither seems to work for you, proceed to option #3.

1) Click on this link and then download it to your computer.  Then print it off and mail it in. membership1112.pdf

2) You should be able to copy the membership form below, by highlighting the form below, right clicking, clicking on copy and then pasting it into n word document you are able to print from.

3) If you are unable to do this please contact our Secretary, Yvonne Hussey (250-843-7622), she will be able to mail you a copy! 




Membership forms

to be mailed to:

PCBRA

c/o Yvonne Hussey

Box 146 Arras, BC

V0C 1B0

A friendly remember:

Jackpot dates count from the

Date stamped on your card.

Any previous jackpots do not count

Towards finals qualification

2011/2012 Membership Form
(one form per person)

Name:__________________________________________________________
Address:________________________________________________________
Email Address:___________________________________________________
Telephone:______________________________________________________
Cell phone:_____________________________________________________

 

Associate Membership - $20.00 -----------------------------------        $__________                     (associate memberships are a membership for non competing members who wish to   vote)

Open Membership - $75.00 ----------------------------------------        $__________                     (open memberships are a membership for those who want to compete)

Youth Membership - $55.00 - Birth Date:   __________-------$__________          
          (16 & under as of August 1st, 2011)

Pee Wee Membership - $35.00 - Birth Date:   ________-------$__________       
          (8 & under as of August 1st, 2011)

TOTAL ENCLOSED: $_________



One Attendance Card per Horse:   Total # of cards Required ________________

In Case of Youth & Peewee Memberships, please fill out below.
Parents Names:__________________________________________________________
Parents Signature:________________________________________________________

I hereby understand that I take full responsibility and I WAIVE ALL CLAIMS against the Peace Country Barrel Racing Association, its executive, directors, members, agents, contractors, employees and facilities, thereof for any and all injury, loss or damage, which I or my property may sustain.



SIGNATURE:_____________________________________DATE:____________________


 
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