MEMBERSHIP APPLICATION

IF YOU WOULD LIKE TO BECOME A MEMBER OF MELODY RIDERS SADDLE CLUB OR RENEW YOUR MEMBERSHIP, PLEASE FILL OUT THE FOLLOWING APPLICATION AND RETURN IT TO THE ADDRESS BELOW:

MEMBERSHIP DUES ARE AS F0LLOWS:

______ $ 28.00 PER PERSON (Must be 18 years of age or older)

______ $ 38.00 PER FAMILY (Must be immediate family group only)

Club rules state that if you are a minor, an adult must join with you. A minor is anyone under the age of 18 as of January 1, current year.

FIRST NAME LAST NAME BIRTHDATE AGE HORSE'S NAME

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

YOUR MAILING ADDRESS ____________________________________________________

Phone Number ______________________________

Emergency Contact _________________________ Phone ________________

RESPONSIBILITY RELEASE CLAUSE AGREEMENT

Except in certain circumstances, any rider or participant in a riding activity at the Melody Riders Saddle Club arena or other MRSC event venue, who is injured there, may not hold the Melody Riders Saddle Club or its officers responsible for his or her injuries, according to Washington State RCW 4.24. You may be asked to sign another release of reliability the first time you register for an event.

I have read the above and agree to the above:

Signature ___________________________________________ Date ____________________

Please mail to: MRSC, P. O. Box 236, Addy, WA 99101

For more information you can contact Oly Burnett evenings at (509) 935-4006

_____ Please check here if you do not want your phone number printed in directory.