Lakehead Light Horse Association 2011 Membership Form

‘Putting the Fun Back Into Horses’

ALL MEMBERS MUST FILL OUT AND SIGN A MEMBERSHIP FORM
Please print clearly

Membership: Family $30.00_________ Senior $25.00_________ Youth $20.00___________

NAME:_________________________________________________________D.O.B___________________(Senior/Youth)

NAME:_________________________________________________________D.O.B___________________(Senior /Youth)

NAME:_________________________________________________________D.O.B___________________(Senior /Youth)

NAME:_________________________________________________________D.O.B___________________(Senior /Youth)
Please attach any additional family members. Seniors may only include day/month to be included in birthday announcements.

Mailing Address:_______________________________________________________________________________________

City:_______________________________________________________________PostalCode:______________________

Telephone:__________________________________ Email:____________________________________________________
(To receive instant newsletters/updates/notices/reminders/invites)

Please check one:

□ I wish to receive my newsletter by email. □ I wish to receive my newsletter by mail.

Please check one:

□ I grant my permission for LLHA to publish photos of myself, and/or my family’s in the newsletter and/or website.
□ I DO NOT wish to have any photos published.

Signature: __________________________________________________

□ I understand the rules stated by LLHA.

□ I acknowledge that any equestrian event can, and may be dangerous. I accept all risks and responsibilities for myself, and my family. I
do not hold Lakehead Light Horse Association, or any members, liable for any injury that may occur to me, my family, or my property. I agree
to not make claim against LLHA, and its members, for any injury or damage that may occur.

This must be signed to be a member:

Signature: _____________________________________________ DATE: ____________________________________

Print Name: ____________________________________________

VOLUNTEERING
(Please check all that applies and your name will be added to a Volunteer list, Volunteers are essential for LLHA )
 I wish to volunteer at Gymkhanas
 I wish to volunteer at Shows
 I wish to volunteer at Social Events
 I wish to volunteer at Fundraising Events
 Other (please specify)_________________________________________________________________________________

Please make cheque payable to: Lakehead Light Horse Association Mail to: Box 201, Kakabeka Falls, Ontario, P0T 1W0

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NAME:_______________________________________________________________________________________________________

ADDRESS:_____________________________________________________________________________________________________

PAYMENT AMOUNT:_______________________MEMBERSHIP TYPE:_______________________CASH_________CHEQUE______