2012 Southern Colorado Barrel Racing Association
Membership Application
_______ $55 Individual Membership
_______
$65 Family Membership (Family members must
reside within the same household)
_______ Required Awards Donation –
minimum $20, may be offset by acquiring
sponsorship for SCBRA. Must be paid by May 1, 2012 or a $15 per month late fee will assessed.
Member
Name: ___________________________________________________________________
Address: _________________________________________________________________________
City, State, Zip Code: ______________________________________________________________
Phone Number: ________________________________________ DOB:______________________
Email Address: ____________________________________________________________________
Please check which division you wish to compete in and have points
counted toward:
______Open
______50+ _______Youth (18 and under) ________Novice Horse
(Note: Novice Horse Division member must complete and attach a Novice Horse Nomination Form, and
the horse cannot have won more than $1000 in barrel racing history)
Member’s
Signature: ________________________________________________________________
For Youth Members
Only
Parent or Guardian Name_____________________________________________________________
Address: ___________________________________________________________________________
Phone: ____________________________________________________________________________
Signature of Parent or Legal Guardian: _________________________________________________
Please review the SCBRA Rulebook located on the website, www.scbra.com
Mail to: SCBRA
Secretary
Mary Carson
1076 E Ohio Ave
Fountain CO 80817
SCBRASecretary@live.com
