Membership Application to Join the SAN JUAN BACK COUNTRY HORSEMEN

Please print a copy, fill in and mail with check to;
SJBCH, PO Box 682, Pagosa Springs, CO   81147


Name: __________________________________________________________________

Address: _________________________________________________________________

City: ___________________     State:_______________                   Zip: _______________

Day Phone: (          ) ___________________        Evening Phone: (             ) ______________

Fax: (              ) ________________________ Email: _____________________________________

____ Family  $35.00                ______ Individual $30.00           ______ At Large $20.00  Support Only

Make Checks Payable :   San Juan Back Country Horsemen

SJBCH may use my e-mail address and/or phone for member-use contact information: Yes____  No____



Participation: I am interested in:

Trails Projects    ____  Social Rides    ____   Education: Meetings/Clinics ____ Fund Raising    _____  Newsletter Assistance _______  Public Affairs ___   Other_________________________

May we contact you for help in your chosen category??   YES ____   No _______


I am aware that the activities involving horses can be inherently dangerous and hazardous, and thereby agree to accept any and all risks of injuries or death that may be associated with participation in events sponsored by the San Juan Back Country Horsemen. I (we) hereby release the San Juan Back Country Horsemen, each and every member, officer and director, agent, employee of any and all liability which may be sustained in connection with the club's activities.

Signature(s) Required

______________________________________________   _____________________________________

Print: __________________________________________   ____________________________________

Date: ________________________________

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