National Professional Rodeo Association

 

              2010 Membership Application

                           (Jan. 1, 2010 to Dec. 31, 2010)

 

 

 

Name:   ________________________________________________________________

Address:   ______________________________________________________________

City:  ______________________________  State:  __________   Zip:  ______________

SS #:  ____________________________   Phone #:  ____________________________

E-Mail Address:                                                    Birthday:  Mo. ____  Day  ____  Yr  ____

 

Membership is $75

 

Make checks payable to NPRA

 

Mail to:  P O Box 212, Mandan, ND 58554

 

Office:  (701) 663-4973      Fax:  (701) 663-5008      npra@btinet.net

 

 

Statement and Release:

 

For good and valuable consideration, the receipt of which I acknowledge, I do for myself, my heirs executors and administrators release and forever discharge the NPRA and all of its officers, agents, employees, committees, and sponsors from all claims, demands, actions or causes of action which may arise on account of my death or on account of any injury which I may suffer while participating in any NPRA Rodeo or other NPRA Event.  In making this statement and release, I further acknowledge that I am aware that Rodeo is a dangerous sport and that serious injuries occur frequently.  I further acknowledge that I have read this statement and that I understand its contents.  I also understand that and agree that Sponsors may subsequently use for publicity or promotional purposes or TV rights my name and/or pictures of me participating in this Association without obligation or liability from me.  I have read the Association information provided, do promise to abide by all Association Rules and Regulations, and certify by my signature below.

 

Signature:   ________________________________    Date:   ________________

 

************************************************************************************

Complete below if applicant is a minor under the Law of the State of Residence

 

I declare that I am one of the parents and/or legal guardians of the above named minor; that I have carefully read the foregoing Statement and Release, that I know the representations made are true; and that I agree to be bound by the terms of the statement and release both personally and as representative of the interests of the minor.

 

Signature:  __________________  Date:  ______   Signature:  _________________ Date:  _______

 

Subscribed and Sworn before me this _____ Day of _________, 20____

 

Notary Public  _________________________  Date Commission Expires ____________