Author: Zinn, Nicole

2017 Membership Application

Please fill out and return to: Heather Ocker 107 Long Road Newville, PA 17241

Please fill out one sheet per PERSON. . You may accumulate points on as many horses as you would like. When entering, you must use the same name for horse and rider. You may use the horse’s registered name or nickname, but the same name must be used throughout the season for both horse and rider. If you use different names at different shows for the same horse or rider, the points will be split up applying points to the separate names as though they were separate pairs. Membership is $25 per person. All around, senior, and youth divisions are included in any open membership.

Name:
Address: ___________________City__________________________________________
State Zip
Phone:
Email: ____________________________________________

Please check all you would like to accumulate points in:
Open Flag ________________ Youth Flag ____________________
Open All Around___________ Youth All Around _______________
Senior Flag _______________ Non—Riding Member ($5) ___________

Release Agreement:
The Keystone Flag Racing Association does not require the use of helmets on any participating riders and will leave this decision to the discretion of the riders and/or parent(s)/legal guardian(s) of those who are under 18 years of age.
I understand that equestrian activity involves certain risks of physical injury of both horse and rider. I, nonetheless, wish to participate in the Keystone Flag Racing Association events. I do so at my own risk and agree to indemnify and hold harmless, the Keystone Flag Racing Association/Directors, volunteers, and those associated from any and all losses, penalties, damages, settlements, costs or other expenses or liabilities arising out of this activity.

Member Signature:
Parent/Guardian Signature:
If under 18: Printed Name of Parent/Legal Guardian:
(If rider is under 18 years of age, then a parent or legal guardian must sign the release agreement.)