Silver State Gymkhana Club Membership Form  2008

MEMBERSHIP fees are as follows:

          INDIVIDUAL                                                 $25 per person, (must be 18 years of age or older).

          FAMILY - SINGLE YOUTH RIDER           $35 (18 years or younger)

FAMILY - 2 OR MORE RIDERS                $45 per family, (must be an immediate family group).

Club rules state that an adult must join with a minor. 

A minor is anyone under the age of 18 years old as of December 31, 2007

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                                                                                                                                   CIRCLE AMOUNT PAID

FIRST NAME                          LAST NAME                              D*O*B   |   AGE   |    $25   $35   $45          _________________________________________________________

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MAILING ADDRESS____________________________________________________________________________

CITY_________________________________________________STATE__________ZIP______________________

PHONE #____________________ CELL #____________________ EMAIL________________________________

PERSON TO CONTACT IN CASE OF EMERGENCY: ______________________________________________

PHONE # _______________________________________

**********RESPONSIBILITY RELEASE CLAUSE AND AGREEMENT**********

In consideration of SILVER STATE GYMKHANA CLUB granting permission to the persons heretofore named, to participate in any or all SILVER STATE GYMKHANA CLUB activities, I the undersigned, individually and as parent or legal guardian of heretofore named minor children, hereby waive all claims, injury to the person, livestock, and/or property of myself and/or minor children which may be caused by an act or failure to act for SILVER STATE GYMKHANA CLUB, it’s officers, agents or employees arising out of or in connection with said activities.

I ACKNOWLEDGE RECEIPT OF “SILVER STATE GYMKHANA CLUB GENERAL RULES”. 

I HAVE READ THE ABOVE AND AGREE TO THE SAME.

SIGNATURE_________________________________________DATE____________________

MAIL MEMBERSHIP TO:      PAM BOYER

                                          P.O. BOX 550597

                                          SOUTH LAKE TAHOE, CA   96155

                                          530*577*2686

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Contact info:  Jill Fry 775-465-2144, Pam Boyer 530-577-2686

email: postmaster@ssgc-horsegames.com