7668 Cornwallis Rd.  Garner, NC 27529
Email:  rci2003@earthlink.net
Make Checks Payable to:  EZ Run PBRA


NAME:  ____________________________________________________

ADDRESS: ______________________________________________________

CITY/STATE:  ____________________________________ZIP:  ___________

TELEPHONE (include area code): ___________________________________

Alternate_________________________

AGE:  ___________        Date of Birth:  ______________________

EMAIL ADDRESS:  _____________________________________________________________

Would you like to receive updates via email? YES  __________  NO  ________

EMERGENCY CONTACT NAME AND TELEPHONE NUMBER:

_____________________________________________________

LEGAL GUARDIAN’S NAME (if under the age of 18):  

_____________________________________________________________

2012 Membership Fee:  $35.00
New Member  _______  Renewal  _______

Classes Competing In:
Youth Barrels  ____            Open 4 D  _______

(You may compete in as many classes as you like)

The information below must be read and signed 
by applicant or legal guardian.

RELEASE FORM

I hereby request membership to the EZ Run Pro Barrel Racing Association aka EZ Run PBRA.  I agree to abide by all rules and regulations and hold harmless the EZ Run PBRA, arena owners, event promoters, sponsors and any person connected with the EZ Run PBRA produced and endorsed events from losses, damages, death or injury to me, my equipment and/or my animals resulting in my attendance or participation in any EZ Run PBRA produced or endorsed event.  I understand and acknowledge that Barrel Racing is a hazardous and dangerous sport and I realize that these activities expose me and my animals to substantial and serious risk of injury or even death.  I hereby release all officers, directors, owners, agents, employees, promoters, contractors, heirs or assigns from any and all responsibility for any injury, accident or loss to person, animal or property due to my association or participation with any and all EZ Run PBRA events, including those that are known or unknown, foreseen and unforeseen past, present, future or contingent to personal, animal or property.  The EZ Run PBRA assumes no liability to those who have not read these conditions and having not read these conditions, they are still held to their contents.

 I understand that the EZ Run PBRA is a privately owned association and the EZ Run PBRA reserves the right to refuse/deny/revoke membership to persons with unfavorable behavior, alcohol/drug use, derogatory speech/actions, animal abuse or reasons deemed appropriate by the owner/director.  I understand that this application is a request on my part for membership to the EZ Run PBRA and is subject to owner/director approval.

This release has been carefully and fully read by the undersigned and the undersigned fully understands its terms and conditions and has voluntarily executed and delivered this release of this date.

Applicant’s Signature:  ___________________________________

Date:  __________________________

Signature:  _____________________________________________

Date:  __________________________