Membership Form

Western Nebraska Cutter

2019 Membership Application

(_)  Single Membership - $30.00         (_)   Family Membership - $35.00

(_) Wrangler Subscription- $8.00

PLEASE make checks payable to Western Nebraska Cutter (WNC)

Name:  _______________________________________________  DOB: _______

            Mailing Address:        _____________________________________

                                                _____________________________________

                                                _____________________________________

            Telephone#:     (_____)            _______________________________

            Email Address:           _____________________________________

Family Members to be included in family membership:                                 Date Of Birth

            1.         _________________________________________              ___________

            2.         _________________________________________              ___________

            3.         _________________________________________              ___________

            4.         _________________________________________              ___________

            5.         _________________________________________              ___________

            6.         _________________________________________              ___________

            Additional Family Members can be added to the back.

** NOTE **   Sign Liability Release on back before returning!

Please Return this application and membership dues to:                 

   WNC

                                                                                                            Tana Miller

                                                                                                           31835 Riverdale Rd

                                                                                                            Pleasanton, NE 68866

                                                                                                            308-641-6494

Western Nebraska Cutters

Liability Release Form

2019

I, the undersigned release any person, stock contractor, or volunteer involved with Western Nebraska Cutters cuttings of an and from all claims, demands, actions, or cause of action, or any kind of nature whatsoever, whether now known or ascertained or which my hereafter develop or accrue me in favor of myself, me heirs, representatives of dependents, on account of or by reason of injury, loss or damage which may be suffered by me, because of any matter, thing or condition, negligence or default whatsoever and I hereby assume and accept full risk of danger of any hurt, injury of damage which may occur through of by any reason or any matte, thing, or condition, negligence or default, or any person whatsoever.

WARNING

Under Nebraska law, an equine professional is not liable for any injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.

Pursuant to section 25-21-153. Nebraska Revised Statues

WARNING

Under Colorado law, an equine professional is not liable for any injury to or the death of a participant in equine activities resulting from the inherent risks of equine activities.

Pursuant to section 13-21-119. Colorado Revised Statues

Competitor     _______________________________________________________

Minor’s Parent or Guardian           _______________________________________

Date    ______________________