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Seniors (19 + yrs.)

Mailing address: (include city/zip)

Print this form and mail to:   Mary Ann Hartzog, Treasurer--24810 Jesse Lee Court, Chugiak, AK 99567

Chugach Range Riders -- Membership Form

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Additional family members - Juniors (18 and under):

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Work phone

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Email

Dues:         $20.00 per year individual membership               Total enclosed (mail to address below) :                    $30.00 per year families/couples                                         $ ________________

JUNIOR MEMBERSHIP Junior applicant (18 years of age or under)  may fill out above form only if one or both parents is/are a member of the CRR, in good standing, and may remain a member until such time as parent/s resign. PLEASE NOTE IF ANY PERSON LISTED ABOVE ON MEMBERSHIP FORM IS A JUNIOR

LIABILITY RELEASE MUST BE SIGNED (if you have not previously submitted a liability form, this membership page must be printed, the liability signed, and form mailed to Mary Ann Hartzog at the above address.) Recognizing that there is potential for an accident wherever horse use is involved, which can cause injuries to horses, riders and spectators; and also recognizing that Chugach Range Riders, including its officers, directors and/or members, cannot know the condition of trails or the experience of riders or horses taking part in Chugach Range Rider functions and activities, I do hereby release Chugach Range Riders, its officers, directors, and members from any claim or right for damages which might occur to me, my minor children or horses. Signature  _______________________________________________    Date:  ______________ Signature  _______________________________________________    Date:  ______________ Dues are not deductible as charitable contributions for income tax purposes.  Dues may be considered ordinary and necessary business deductions.

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