IBRA MEMBERSHIP APPLICATION

Please circle:

$50.00 Open (includes 40 & over)

$30.00 Youth (16 yrs. & under as of January 1st)

$10.00 Pee Wee (8 yrs. & under as of January 1st)

$100.00 Family (Adult, spouse and children 18 yrs. & younger as of January

1st)

______ New Membership ______ Renewal - Membership No._________

Name: _____________________________________

Address: ______________________________ E-mail: _________________________

______________________________

Phone: ______________________________

Birth Date: ______________________________

For Family Membership:

1st Member: ______________________________ Birth Date: _________________

2nd Adult: ______________________________ Birth Date: _________________

Child: ______________________________ Birth Date: _________________

Child: ______________________________ Birth Date: _________________

Child: ______________________________ Birth Date: _________________

I hereby request membership with the Independent Barrel Racers Association (IBRA). I hereby agree to become familiar with all of its rules and regulations and I will abide by and be bound by them. I further agree to release the show organizer, the IBRA, the hosting arena, and any official, employee, or agent of same, from any claim or right for damages, which may occur to myself, my family, my horse(s) or my personal property at any IBRA event.

Dated this ______ day of _______________, 20___.

Signature:_____________________________________________ Date:_________________

If applicant is a minor, their parent or legal guardian must sign below.

Guardian Signature:_____________________________________ Date:_________________