KANSAS PROFESSIONAL RODEO ASSOCIATION
2012 MEMBERSHIP APPLICATION
Can fill out online and then print off and mail with check to:
PO Box 727, Goodwell, OK 73939
NAME SOC SEC
ADDRESS
CITYSTATEZIP
HOME PH#CELL #DOB
EMAILJACKET SIZE
EVENTS: BB SB BR TD SW BAW LBR TR HEADER
TR HEELER 40/40 HEADER 40/40 HEELER
**MEMBERSHIPS WILL INCREASE $15 AFTER JUNE 1ST**
(Check membership requested)
Membership dues $125 ($140 after June 1st) ($75 membership plus $50 finals fund)
Youth Membership $90 ($105 after June 1st) ($40 membership plus $50 finals fund)
Under 18 - must complete notarized Minors Form
Companion pass $10 (one per contestant)
Non-contesting card $35 - please designate - Announcer Judge Pickupman
Stock Contractor Bullfighter Timer Secretary Committee Other
Check here if you qualify for rookie - if you have not been, or currently a member of any other amateur or professional association (including permit holders).
I agree to abide by the rules and regulations of the KANSAS PROFESSIONAL RODEO ASSOCIATION
(KPRA) and not hold the KPRA responsible for any related incidents or accidents involving the KPRA.
I hereby waive and release any and all claims against the KPRA, its officers, directors and employees.
I give the KPRA permission to publish my name and monies won in the official association
publication and on the association website. This provision shall be binding upon said member,
his or her legal representative, heirs, successors, and assigns.
_________________________________________ ____________________
Signature Date
FOR OFFICE USE ONLY:
CARD #_______________DATE REC'D_____________PAID:____________________