Membership Application for
OLYMPIC CHAPTER (P.O. Box 1629, Silverdale, WA 98383) of the BACKCOUNTRY HORSEMEN OF WASHINGTON, INC. - (STATE and Olympic Chapter Membership for 2008 Calendar Year)
Membership: New______ Renewal______ (Optional Memberships below)
| Family | State: $49 | Olympic Chapter: $7 | Total due: $56.00 | |
| Single | State: $36 | Olympic Chapter: $7 | Total due: $43.00 | |
| Additional State Donation? | ||||
| Additional Chapter Donation: |
| Contributing | $ 65.00 | $__________ | |
| Sustaining | $100.00 | $__________ | |
| Patron | $250.00 | $__________ | |
| Benefactor | $500.00 | $__________ | |
| Chapter dues | $ 7.00 | $__________ |
| TOTAL AMOUNT ENCLOSED: | $___________ |
Name(s)_______________________________________________________________________________ Address_______________________________________________________________________________ City/State/Zip___________________________________________________________________________ Phone:_______________________________Cell Phone_____________________________ Email:_________________________________________________________________________________
LIABILITY RELEASE MUST BE SIGNED - All members, including children, must sign this Liability Release: Recognizing the fact that there is a potential for an accident wherever saddle stock use is involved, which can cause injuries to stock, riders, and spectators, and also recognizing the fact that Backcountry Horsemen of Washingon, Inc., including chapters, officers, directors, or members cannot always know the conditions of trails or the experience of riders or stock taking part in Trail Rides or other BCHW functions, I do hereby release the above named from any claim or right for damages which might occur to me, my minor children or saddle stock.
Signed________________________________________________________Date_______________ Signed________________________________________________________Date_______________ Signed________________________________________________________Date_______________ Signed________________________________________________________Date_______________ - - - - - -(If child is too young to sign; guardian must sign their name, then indicate who, i.e., by mother/father, etc.)
Areas of Interest - Circle any/all that apply: Trail Maintenance/Work Parties; Rides; Packing; Social Gatherings; Public Events; Parades or Fairs; Leave No Trace edu.; Fund raisers; Green Mountain Camp Host Program; Horse Legislation; Cooking/Refreshments