|
FIRST
NAME: _____________________MI. ______LAST NAME: _______________________
ADDRESS:
_______________________________________________________________
CITY:
______________________________ STATE : ________________ ZIP:
_____________
PHONE
#: ( ) ________________________
MOBILE #:
( ) ______________________________
DOB:
_____________ AGE _____________ PREVIOUS
CARD : NO or YES #___________
E-
MAIL ADDRESS __________________________________________________________________
S.S.
# _____________________________
JACKET SIZE: S M L XL 2XL 3XL
(Circle only one size, jacket for year-end finals)
SIGNATURE:
___________________________________ DATE:
__________________________
COMPETING
MEMBERSHIP $100.00 (PLEASE ONLY CHECK EVENTS YOU COMPETE IN)
BAREBACK
_____ SADDLE BRONC ______ BULL RIDING ______ CALF ROPING
______
STEER
WRESTLING ___ TEAM ROPING ___ BARREL RACE ____ LADIES BREAKAWAY
____
NON-COMPETING
MEMBERSHIP $50.00 (PLEASE CHECK EVENTS IN WHICH YOU WORK )
ANNOUNCER
_______ SECRETARY _______ TIMEKEEPER _______ BULLFIGHTER _______
CONTRACTS
ACTS _______ PICK-UP MAN _______ JUDGE _______OTHER______________
RODEO
SECRETARY USE ONLY
Rodeo
that card was purchased at: _________________________
Paid:
Cash _________ Check #________Credit Card ________ (used only through
the CPRA Office) |