Tri-county Horsemen, Inc.

Membership application 2010

Name_______________________ Horses’ Name_________________

_________________

__________________

Birth Date____________Age of 12/01/09

Address_____________________________

City, State, & Zip Code_____________________________________________________

Telephone number:_____________________e-mail address: ______________________

Membership type:_______Individual ($15.00) _________Family ($30.00)

Please make checks payable to Tri-County Horsemen, Inc

Send to: Marilyn Smith, 152 North Shore Drive, Owls Head, ME 04854

Family Members:

1. Name ________________________________Birthdate_________as of 12/01/09

2. Name_________________________________Birthdate_________as of 12/01/09

3. Name_________________________________Birthdate_________as of 12/01/09

4. Name_________________________________Birthdate_________as of 12/01/09

Payment of membership fee covers the calendar year 2009. Membership fees must be paid in full before the horse show points will begin to accrue for yearend awards.

Disclaimer: I hereby enter this organization at my own risk subject to all rules and regulation of Tri-County Horsemen, Inc. I further agree that if any damage or loss occasioned to any horse, pony, rider, vehicle or article, I will make no claims against Tri-County Horsemen, Inc., its officers or club members. I further agree to indemnify and hold harmless Tri-county Horsemen, Inc. for any injury to any person or animal or damage to any property caused to or by my attendant, my animal or myself.

Signature required by member AND parent or guardian if member is under 18.

Member:_________________________________________

Parent/Guardian___________________________________