05Membership

2008-'09 Membership Application

Warning Under Florida law, an equine activity sponsor or equine professional is not liable for an injury to, or the death of, a participant in equine activities resulting from the inherent risks of equine activities. Participants in equine activities should be aware of, and attempt to minimize, the inherent risks involved. Riders should:Wear properly fitting approved headgear whenever mounted Not engage in unsafe behavior, be mindful of the actions of the animals, whether mounted or afoot. “I am aware of the Florida law regarding equine activity sponsors and I understand the inherent risks of equine activities. I release Gold Coast Arabian Horse Club of Florida & it's sponsors from all responsibility regarding injury, death or damage to myself, my horse, or my personal property.” By signing this form I agree to all of the above.

Print name of participant: ____________________________________

Signature of participant:______________________________________

Signature of parent or guardian:_______________________________(if under 18)

Participant’s phone #:________________________________________

Contact Name case of an emergency: __________________________

Contact’s phone #:____________________________________________

Insurance Co. & Policy # (optional):

____________________________________________________________

New_____ Renewal_____ * PLEASE FILL OUT THIS FORM COMPLETLY

__1 Local Adult Membership $20

__1 Local Family Membership $25 TOTAL Family Members______ Mail to: Mary Ann Luna

__1 Local Adult & AHA Membership $35 without Competition Card 16701 W. Goldcup Dr.

__1 Local Adult & AHA Membership $55 with Competition Card Loxahatchee, FL 33470

Existing AHA Member #_______________________________________

__1 Local Family & 1 AHA Member $60 w/AHA Competition Card

Specify Name of Individual for IAHA Membership:

_____________________________AHA#:_________________________

__1 Local Youth Membership $15 (under 18 years old)

__1 Local Youth & AHA w/NoCompetion Card $20

__1 Local Youth & AHA w/Competion Card $25

Existing Youth AHA Member # (if applicable)____________________

!!!__Late AHA Renewal, please add $10.00 (after Dec. 15)!!!

(if you are a new AHA member, you need not pay a late fee)

__Subscription to HORSE & PONY (1/2 price) $10.00

TOTAL ENCLOSED $ ___________ (make checks payable to GCAHC)

Name_____________________________E-Mail:___________________

Address____________________________________________________

City_____________________ State_________ ZIP_________________

Phone(s) ___________________________________________________

Social Security #_________________________ (required for AHA only) (we do not keep this information in our files)

(Date of Birth - required for youth members ______/______/______)

I hereby apply for membership in the Gold Coast Arabian Horse Club of Florida. I agree to abide by its bylaws and charter. I release all rights to any photos taken for advertising & website publications.

I have read and signed the release form on the top & bottom of this application.

Signature______________________________________Date___________

http://goldcoastarabianhc.homestead.com