Liberty Gay Rodeo Association Membership Application

Individual $20     Family $35     Independence $150     Lifetime $500     Business $250

Full Name (First Last)
Address


City
State
Zip
Phone
E-mail
Birth Date (MM/dd/YYYY)

How would you like your name listed?
My full name
My first name & last initial
Do not print my name
My alias

Are you interested in being a competitor?
Yes     No

Are you a member of another Rodeo Association?
If so, please list them? Note: You are allowed and encouraged to be a member of multiple rodeo associations.

If Family membership fill in second person's info here
Name
Birth Date (MM/dd/YYYY)
E-mail if deferent than above Phone if deferent than above

My full name
My first name & last initial
Do not print my name
My alias

Are you interested in being a competitor?
Yes     No

Interested in becoming more involved in LGRA?
Please indicate the committees you are interested in:
Fund Raising
Newsletter
Public Relations
Rodeo Training & Events
Membership

How would you prefer us to contact you?
Email
Phone
Alternate phone:

Please indicate any other special skills you have:

The fine print: By checking this box, I agree to conduct myself to conform to the bylaws and standing rules of LGRA. I further agree in connection with my participation or attendance of any event held by or for the benefit of LGRA to always comply with all applicable laws. I acknowledge that failure to do so may be cause for the termination of my membership. I acknowledge that failure to pay all dues or assessments, if any, shall give rise to termination of my membership. I hereby agree to protect and hold harmless LGRA from any and all damage, injury or death which might occur to my property or person in preparation for, during or immediately following any function held by or for the benefit of LGRA and also from any and all liability whatsoever in regard thereto whether any cause of action may occur to me, my executor administrator or assign. Check this box to indicate that you agree to the above You can not precede without checking this box.

Double check your info, there is no conformation screen after submitting
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