ERRSC MEMBERSHIP FORM

 

Name:_____________________________

 

Address:___________________________

              

               ___________________________

 

Phone # :___________or Cell #________

 

Email:_____________________________

 

Name if kids 17 & under at same Address:

 

____________________________________

 

______________________________________________

 

______________________________________________

 

______________________________________________

 

Membership amt paid $_____ Rcvd by:____ Ck#/cash____

 

Annual Dues Family (living at same address under 18) $25.00

Individual (under 18 must have parental signature) $20.00

 

Parent/guardian signature___________________________

 

WARNING:  Under Missouri Law, an equine professional is not liable for injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.