2009 MID-STATES RODEO ASSOCIATION    
MEMBERSHIP APPLICATION    
  THIS RELEASE MUST BE SIGNED, NOTARIZED, AND
_____ NEW MEMBER  _____RENEWAL MEMBER   RETURNED TO THE MID-STATES RODEO OFFICE
  BEFORE YOU WILL BE CONSIDERED A MEMBER AT ANY
NAME __________________________________________   MID-STATES SANCTIONED RODEO.
ADDRESS _______________________________________    
CITY  __________________________________________   I, _____________________________________as a member of the 
STATE __________________ ZIP ___________________   Mid-States, a Nebraska Corporation, hereby acknowledge that rodeos
PHONE ________________CELL ____________________   are dangerous activities and that participation in a rodeo as a 
E-MAIL ________________________________________   competitor, an independent contractor, or a volunteer, exposes the
SOCIAL SECURITY #  _________-________-_________   participant to a substantial and serious risk or property damage, 
BIRTHDAY __________________________   personal injury, or death.  It is specifically acknowledges that
  participation in a Mid-States Rodeo Association sanctioned rodeo
RENEWAL MEMBERS
   will involve such a hazard.  Being fully aware that participation in
JANUARY 1 TO APRIL 30                    AFTER MAY 1   Mid-States sanctioned rodeos will expose me to substantial and
1 PERSON $80/1 NEWSLETTER $15     $95 ___                    $100 ___   serious risk or property damage and/or personal injury or death, I
2 PEOPLE $160/1 NEWSLETTER $15   $175 ___                    $185 ___   hereby release the Mid-States sanctioned rodeos, production entity,
2 PEOPLE $160/2 NEWSLETTER $30   $190 ___                    $200 ___   their affiliated, related or subsidiary companies and the officers,
$40 returned if $100 sponsor turned into M-SRA by Aug 1st, 2009   directors, employees, sponsors, and agents of each entity or
  organization from liablity for any and all property damage, personal
NEW MEMBERS   injuries, or to the claims arising from participation in Mid-States
1 PERSON $55/1 NEWSLETTER $15              $70    ___   Rodeo Association sanctioned rodeos, including claims which are
2 PEOPLE $110/1 NEWSLETTER $15             $125  ___   known and unknown, foreseen, future, or contingent.  I agree that I
2 PEOPLE $110/2 NEWSLETTER $30             $140  ___   shall not, now or at any time in the future, directly or indirectly 
HIGH SCHOOL MEMBER*                            $15    ___   commence or prosecute any action suit or other proceedings against
    *WILL NOT BE CONSIDERED ROOKIE YEAR.  Cash only and a copy of   the before mentioned arising out of or related to the action, causes of
     high school rodeo card must be included with application form.   action, claims and demands upon me, my spouse, legal
     MUST BE SIGNED BY PARENT OR GUARDIAN.   representatives, heirs, successors, and assigns.
( CASH or a MONEY ORDER ONLY)    

$40 returned if $100 sponsor turned into MSRA by Aug 1st, 2009

   MEMBER'S SIGNATURE_______________________
   
CONTRACT PERSONNEL                               $50 ____   STATE OF ________________________________

CONTRACT PERSONNEL$50/NEWSLETTER$15   $65 ____

    

PLEASE MARK ALL THAT APPLY:

   COUNTY OF ______________________________
JUDGE ____                      SECRETARY ____     
PICKUP MAN ____            TIMER ____   NOW ON THIS THE ____ DAY OF ________, 2009,
ARENA DIRECTOR ____    CLOWN ____    
ANNOUNCER ____            BULLFIGHTER ____   (name) ________________________________
  Has personally appeared before me, a notary republic in said above 
STOCK CONTRACTORS                                 $25____   state, and appears to me to be the identical person who signed the 
STOCK CONTRACTOS$25/NEWSLETTER$15      $40____   above release and acknowledged the execution thereof to be a 
NEWSLETTER ONLY                                     $15____   voluntary act and deed.
  WITNESS BY HAND AND NOTARIAL SEAL ON THE 
PLEASE CIRCLE THE EVENT(S) YOU WORK.   DAY AND YEAR LAST ABOVE WRITTEN.
   MEN  --  BB    SB    BR    CR    45CR    SW    
                       TR-HDR    TR-HLR    
  WOMEN --  LBA    LBR    MTR    GT    
  NOTARY PUBLIC:_________________________________
Is this your first year as a member of the M-SRA?______    
Have you ever belonged to any other associations?____   IF YOU ARE UNDER 19, YOUR PARENT/GUARDIAN MUST SIGN: 
If so, which?____________________________________    
  PARENT SIGNATURE___________________________
  (RELEASING THE ABOVE MINOR TO PARTICIPATE IN 
PLEASE MAIL BACK TO:     THE ABOVE SPORT WITH YOUR CONSENT.)
MSRA--JILL AUSTIN    
819 SOUTH 8TH STREET   OFFICE USE ONLY
NORFOLK, NE 68701   DATE RECEIVED ______      AMOUNT RECEIVED ______
(402)992-4427   CARD # __________