Amped Up Pro Bull Riding

Tour
Membership Application 2017
Fill out and mail to: Amped Up Pro Bull Riding Tour,
350 SE 471 Warrensburg, MO 64093
Email: ampedupproductions@yahoo.com web site:
ampedupprobulltour.com
Name:_______________________________________________________________________
_
Address:_____________________________________________________________________
_
City:___________________State_________Zip
Code__________________________________
Home Phone:____________________Cell
Phone:_____________________________________
Emergency
Contact:_______________________Phone:________________________________
Email
Address:_________________________________________________________________
DOB_______________________________Social Security
#_____________________________
[ ] New Member [ ] Renewal
Membership Dues $100 - Make payable to: Amped Up Productions

Bull Rider [ ]
Stock Contractor [ ] Jacket Size______________

I do hereby release the Amped Up Pro Bull Riding Tour, all

members, producers, contractors, committees, and Board of
Directors from any and all liabilities for any damages or injuries.
State of:_______________ County of:________________________
I certify this to be the original document on this ______Day
of______, 20_____,
Notary Public
Signature:_______________________________________________
My Commission
Expires:_______________________________________________
Applicant
Signature:________________________________Date:______________
*Parent Signature(if under
18):________________________Date_____________