The best way to fill out the Membership Card on-line would be to copy and paste it to word and then email it to us in an attachment!
Skiatook Roundup Club
Skiatook, Ok 74070 Card#_____
Single $20.00____ Family$25.00 ____
(Anyone over the Age of 21 must obtain their own Membership Card and anyone under the age of 18 must have a parent’s signature)
(To Compete at Cavalcade or Fair Day Dues need to be paid by April 1)
Memberships Run From January 1ST 2009 tell
PLEASE PRINT CLEARLY
Name: ______________________________
Spouse: _____________________________________
Address: _________________________
City: ___________________ State: _________ Zip: _______
Phone (1):___________Phone (2):___________ Email: __________________
Children:
1________________________________ D.O.B ____________________
2. _______________________________ D.O.B ____________________
3. _______________________________ D.O.B ____________________
4. _______________________________ D.O.B ____________________
5. _______________________________ D.O.B ____________________
6. _______________________________ D.O.B ____________________
This is between the Skiatook Roundup Club and the names listed above:
1.) The members must abide by all rules and bylaws set forth by the Skiatook Roundup Club.
2.) All decisions must be brought before the Board
3.) I understand there are certain risks and dangers involved in participating as a member of the Skiatook Roundup Club and I herby assume all risk of injury sustained at person(s) or loss to my property resulting form my participation in a club event.
4.) I do hereby release the Skiatook Roundup Club and the AT Ferree Estate and all members from all claims, demands, actions, and causes of action of any sort of injury sustained.
I HEREBY AGREE TO ALL LISTED ABOVE
Signature: ________________________ Date: _______________________
Playday Release
Emergency contact: _________________________________
Phone (1): ________________ Phone (2): _______________
I prefer my child(s) to be taken to which Hospital: ____________________
List medications your child is on: __________________________________
Drug Sensitivities: _____________________________________________
If more space needed please list on back.
Office Use Only:
Date PD: ___________________ Amount Paid: ___________ Check# _______ Cash ___________
