♦Name

♦Address

♦City

♦State

♦Zip Code

♦Home Phone

♦Cell Phone

♦Emergency Contact Name

♦Emergency Contact Phone #

Social Security #

♦Date of Birth

♦Team Position

♦Occupation

♦E-mail Address

♦Do you consent to receive official PWHRA correspondence via e-mail?
Yes No

♦Membership Type
PWHRA Full Membership $175
* INCLUDES ONE COMPANION PASS Rookie Membership $100
* DOES NOT INCLUDES COMPANION PASS Judge’s Card $75
* New judges must pass the current judge’s test
* INCLUDES ONE COMPANION PASS Day/Per Go Permit - $35 per go
* DOES NOT INCLUDE COMPANION PASS Companion Pass $50
* May be purchased by Permit or Regional Permit holders, limit one.

Membership fees must be received to the National Office in order for you membership to be effective.

Full Membership includes voting rights, a subscription to the Association newsletter, one companion pass, check writing privileges and entry advantages.
Regional Permit includes a subscription to the Association newsletter and entry advantages; however you may only participate in rodeos in your region and only four rodeos count for Regional points. You must be a full member to participate in the PWHRA National Finals. Permit holders do not have the right to vote.
Rookie Membership is only applicable for a first-time member of the PWHRA. Rookies do not have the right to vote.
Judge’s Card includes voting rights, a subscription to the Association newsletter and one companion pass.

♦Please check here if you wish to allow the PWHRA to release your contact information
Yes No

By submitting this application and paying the appropriate membership fee to join the PWHRA, I agree to abide by all rules and bylaws of the Association. The rights and obligations of the PWHRA, its Directors, Officers and Members shall be governed by the laws of the state of Oregon. The venue for any legal action by a member against the PWHRA, its Directors or Officers shall be in Jefferson County, Oregon. I declare that all information provided by me on this application is true and correct and I hereby release the PWHRA, its Directors and Officers from liability for any actions they may take by relying on this information. It is my responsibility to notify the PWHRA if any information contained on this application must be updated.

♦I have read and awknowledge the submission terms.
Please inital in the box below.

I am aware of and voluntarily assume all risks and dangers to property and myself including, but not limited to, accidents, injury and death to which I may be exposed by participation in a PWHRA sanctioned wild horse race event. I am free to make choices governing my own safety and I participate voluntarily, despite the inherent dangers and risks. I further authorize any person(s) present to seek and render emergency medical treatment on my behalf in connection with my participation in the said activities. I acknowledge and agree that the PWHRA, its Directors, Officers and Members will assume no responsibility for, and shall be released from, any claim or liability relating to any injury or damage, which might arise out of or in connection with such authorized medical treatment.

♦I have read and awknowledge the safety terms.
Please inital in the box below.

I shall indemnify, defend and hold harmless the PWHRA, its Directors, Officers and Members from all liability, loss, cost, damages, claims or causes of action of any kind or nature whatsoever, and expenses (including attorney’s fees) arising or claimed to have arisen out of personal injuries or death, or property damage or loss, sustained by me during my participation in this activity (including travel to and from any rodeo). No PWHRA Director, Officer, judge, contestant, rodeo committee or other sanctioning organization can be held responsible for injuries or loss sustained while competing in any manner in a wild horse race. I understand this clause and release all entities mentioned above as evidenced by any entry into a PWHRA sanctioned wild horse race event.

♦I have read and awknowledge the indemnify clause.
Please inital in the box below.

I am 18 years of age or I have included a parent/guardian’s signature where indicated. By my signature below I certify that I have carefully read this agreement, fully understand its contents, voluntarily sign it, and realize that it will legally bind me, my heirs, and my personal representatives.

♦I have read and awknowledge the PWHRA waiver.
Please type your name in the box below to electronically sign this document.

Validate & Submit
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