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St. Lawrence Valley Horseman’s Association Membership Application
Membership Type Family ($18.00) Individual ($12.00) Junior ($6.00) *Family Membership can Include Grandchildren Under 18 Yrs. Of Age
PLEASE LIST ALL OF THE MEMBERS TO BE INCLUDED ON THIS MEMBERSHIP
I HEARBY ATTEST THAT ALL OF THE INFORMAITON ON THIS APPLICATION IS COMPLETE AND TRUE. ALSO, IN CONSIDERATION OF THE ACCEPTANCE OF MY REGISRTATION FOR THIS EVENT, I HEARBY WAIVE, RELEASE AND DISCHARGE ANY AND ALL CLAIMS FOR DEATH, PERSONAL INJURY OR PROPERTY DAMAGE WHICH I MAY HAVE, OR WHICH HEREAFTER MAY ACCUTE TO ME, AS A RESULT OF MY PARTICIPATION IN THIS EVENT. THEIS RELEASE IS INTENED TO DISCHARGE, IN ADVANCE THE PROMOTERS, SPONSORS, OFFICIALS AND ANY INVOLVED MUNICIPALITUES OR OTHER PUBLIC ENITIES FORM AND AGAINST ANDY AND ALL LIABILITY ARISING OUT OF, OR CONNECTED IN ANYWAY WITH MY PARTICIAPTION IN THIS EVENT. IT IS FURTHER UNDERSTOOD AND AGREED THAT THIS WAVIER IS BINDING ON MY HEIRS AND ASSIGNS.
Please return form to: Marcia Oney 875 Ruddy Rd. Chase Mills, N.Y. 13621 OR Lillian Pitts 181 Willard Rd. Massena, N.Y. 13662
E-Mail : Marcia Oney |