CAMP VERDE GYMKHANA ASSOCIATION
S
ign up Sheet
2010-2011.
Name
.
Phone Number: ( )
- .Email address:
.
Mailing Address:
.
City: State: Zip:
.
Name:
DOB: .
Name:
DOB:
.
Name:
DOB:
.
Name:
DOB:
.
Name:
DOB:
.
Name:
DOB:
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DUES: A one time fee of.
Individual Membership*
Verde Fair & Rec.
$ 15.00
CVGA $ 20.00
Total Individual Dues:
$ 35.00 $
.
Family Membership
*
*see rules and regs to see if you qualify.
Verde Fair & Rec.
$ 25.00
CVGA $ 30.00
Total Individual Dues: $ 55.00 $
.
Schooling Membership
Verde Fair & Rec. $ 15.00
CVGA $ 10.00
Total Individual Dues: $ 25.00
$ .
Received by: Date:
Amount paid:
.
Waiver and Release
I/We Hereby waive and release, and enter into this gymkhana series at my own risk. In the event of any accident, death
to myself, my family, my horse or my vehicle and/ or equipment, or any theft, I will not hold the Camp Verde Gymkhana Association,
Verde Fair & Recreation, Arena Del Loma or anyone connected with the gymkhana in any way liable or responsible.
I/ We agree to comply with all the Camp Verde Gymkhana Associations, Verde Fair and Recreation, Arena Del Loma rules and
regulations, posted at the arena, and agree that if I fail to comply with all the rules and regulations, I will be asked to
immediately leave or be result in permanent loss of privileges to Arena Del Loma. Entries will not be accepted unless this
application/ release form has been fully completed and signed.
X
Date .(Parent/ Guardian must sign
if contestant is a minor)
This is the membership form for CVGA and Verde Fair & rec. association combined. You must belong to both associations
to compete.
