CTR Membership Form

COWBOY MOUNTED SHOOTING CLUB MEMBERSHIP FORM
Membership Year
Paid via check
Paid via PP
Name*
D.O.B.*

MonthDayYear
Date
Address*

Address

Street Address Line 2

CityState

Zip Code
Email*
example@example.com
Home Number
Please enter a valid phone number.
Cell Number
Please enter a valid phone number.
CMSA #*
CMSA Class*
CMSA Exp. Date*

MonthDayYear
Date
Family Members: (for family membership only)
Name
DOB

MonthDayYear
Date
CMSA #
CMSA Level
CMSA Exp Date

MonthDayYear
Date
Name
DOB

MonthDayYear
Date
CMSA #
CMSA Level
CMSA Exp Date

MonthDayYear
Date
Name
DOB

MonthDayYear
Date
CMSA #
CMSA Level
CMSA Exp Date

MonthDayYear
Date
Membership Benefits: As a member, you will receive regular communications, match results, and notice of registration for upcoming shoots or clinics. You are entitled to vote at club meetings. You will help promote GUN SAFETY as well as enjoy being a part of a fun, family sport. For more information contact: Thomas Beckman 860-960-4862 or CTRenegadesCMSA@gmail.com.
Individual Membership: All persons wishing to participate in activites, voting and year-end awards.
12 years of age and up as of January 1st $25.00
11 & under $20.00
Associate membership (non-rider) $10.00
Family Members: (for family membership only)

Those persons living under the same roof in a spousal relationship and/or their children under the age of 18
Up to 4 family members $30.00
• Add $10 each additional child over 4 total members $10x
Makes Checks payable to: CT Renegades or pay via PayPal (using Friends) on CTR website
Total Owed $*
Liability Release Form
I understand that I am participating in a sport which contains dangers, and risks may arise, including, but not limited to, accidental injury, the forces of nature and illness. In consideration of the right to participate in these events and the services provided for me by the Connecticut Renegades or Cowboy Mounted Shooting Association and its agents, I have and do hereby assume the risks associated with such events. The contestant shall at his own expense, defend management and/or all sponsors, their members, or employees from any and all such claims and indemnify, from any and all liability, damage and costs arising from injuries to person or property occasioned by any act or omission of the contestant.
Signature of Applicant*
Date*

MonthDayYear
Date
If form not completed online mail to: Heather Hicks, 9 Brookview Dr Southwick, MA 01077
Should be Empty:

COWBOY MOUNTED SHOOTING CLUB MEMBERSHIP FORM

Liability Release Form