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Atlantic States Gay Rodeo Association

Membership Application

This form is for New and Renewal Memberships via Credit Card only.
To pay by check please use the printable form

Please make sure your e-mail address is correct.
You should receive a conformation e-mail within 48 hours,
if not please contact us at

Red fields must be completed

New member             Renewal     Membership #

Full Name (first last)
Birth date (MM/dd/YYYY) (optional)
In the ASGRA newsletter you may print: My full name
My first name & last initial
My alias
Do not print my name
Home Phone
Work Phone
Address:       Street

Your E-mail Address: profile name
will receive a free 1 month Gold membership

All ASGRA memberships run from January 1st through December 31st.
Regular $  30
Family $  55 (2 people living at the same address)
Silver Spur $125
Business $200
Golden Saddle $425
Lifetime $600
Fill in this part ONLY if you are applying for a Family Membership
enter the following for the Second Person
Second Person's Name  
Second Person's e-mail  
You may print in the newsletter: My full name
My first name & last initial
My alias
Do not print my name
Birth date (MM/dd/YYYY)   (optional)

By submitting this application I hereby agree to the following:
  • To conform to the bylaws, standing rules and any other rules adopted by the Board of Directors or other officials of ASGRA.

  • To comply with all applicable laws when participating in or attending any ASGRA sponsored event.

  • To pay any of my required ASGRA or IGRA dues or assessments on time.

  • To not hold ASGRA responsible for damage, injury, liability or death, to me or my property while in preparation for, during, or immediately following any ASGRA sponsored function which I attend. This affirmation includes me, my executor, administrator, and assigns.
I understand that failure to follow these rules may result in termination to my membership

Check this box to indicate that you agree to the above
AND that you are 18 years of age or older

You cannot proceed without checking this box.

Double check your entries first
There is no conformation screen after you click submit

Click the Home button at top of page to cancel

Last update
Mar 6, 2014