2026 C.M.H.A. MEMBERSHIP FORM

Member First Name:

Member Last Name:

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Members Date of Birth

Membership Type-choose one

Payment Options-please choose one

Back Number(s)

All C.M.H.A exhibitors are required to have an assigned back number to show. You need a different back number for each horse/rider combination shown. C.M.H.A. offers back numbers 1-600 ONLY, if you want to use a back number higher than 600, you will have to provide your own number(s). Each exhibitor will receive one set of two (2) back numbers that are waterproof, with their membership. The reserved back numbers will be available in the show office, at the first show attended. Any questions or for more information, please contact the secretary at cmhasec70@gmail.com. Memberships may be purchased at the shows, but to save your 2026 back number your membership form and payment must be received no later than April 1st 2026** if your first 3 choices of a back # are not available, one will be assigned to you.

Please add a comment in the "note" section, if you are showing more than one horse ex: 1, 2, 3 etc. and we will do our best to get you the number(s)you request and for multiple horses to be show.

**IF you are not planning to show, are only showing in DRESSAGE, or are purchasing a membership to support your club, vote (adults 19 & older) at the membership annual meeting, etc. please leave the back # sections blank.

Back Number Choice #1

Back Number Choice #2

Back Number Choice #3

*Note to C.M.H.A. (additional information regarding back # requests) Please email cmhasec70@gmail.com with any questions regarding back numbers or this form. Membership and back numbers are not considered complete/assigned until both this form and payment have been received. Please complete this form electronically, PLEASE DO NOT print and complete. MUST BE SUBMITTED ELECTRONICALLY for our records. REMINDER to send payment either a check by mail or Pay Pay.

Central Michigan Horsemans Association

Waiver & Release

This must be read and signed by the exhibitor listed above or the parent/legal guardian if the exhibitor is under 18 years old.
I AGREE THAT Central Michigan Horseman’s Association (CMHA), its officers, members, exhibitors, and volunteers, shall not be responsible for any loss, damage, or injury resulting to me. I further agree to hold them harmless against and from any claims, causes of action, liabilities or damages that
may arise as a result or in connection with my participation in any practice or events through CMHA. I further release and forever discharge
CMHA, its officers, members, exhibitors, and volunteers, from any and all claims, liabilities, damages, losses, costs and expenses, of any nature whatsoever,
known or unknown, direct or indirect, arising in law or in equity, in connection with any CMHA activity.
I understand that the liability coverage held by CMHA (as required by the Shiawassee County Agricultural Society (fairgrounds)),
covers spectators only, and does not cover any rider in any class. The coverage does not include bodily injury to any rider or personal liability
losses. I understand that I am responsible for my own healthcare coverage and /or personal liability insurance for myself and for my horse, as
well as for the minors listed below, which I agree to be fully responsible for, and understand that the above fully applies to them as well. CMHA
strongly recommends that you carry your own healthcare and personal liability insurance.
Warning:
Under the Michigan Equine Activity Liability Act, an equine activity sponsor, an equine Professional, or another person is not liable for
an injury to or the death of a participant in an Equine activity resulting from an inherent risk of the equine activity.
(MCL, ACT.1994.35 1)

CENTRAL MICHIGAN HORSEMAN’S ASSOCIATION
RELEASE FOR AUDIO, VIDEO, FILM, AND PHOTOGRAPHS
Participants in events sponsored/hosted by the Central Michigan Horseman’s Association (C.M.H.A.) are sometimes photographed and
videotaped for use in, but not limited to, C.M.H.A. promotions, advertisements, website, etc.
I authorize C.M.H.A. to record any image and/or voice of the subject named below and gives C.M.H.A. and all persons or entities acting pursuant to C.M.H.A.'s
permission or authority, all right the use of these recorded images and voice. I understand that said images and/or voice will be used for advertising and
promotional purposes in all conventional and electronic media, including but not limited to the internet, and any future media. I also authorize the use of any
printed material in connection therewith.
I understand and agree that these images and recordings may be duplicated, distributed, with or without charge, and/or altered in any form or manner without
future or further compensation or liability, in perpetuity.
I release and hold harmless any and all liability of C.M.H.A. because of the use of this material.

By clicking "I agree" below and signing your name below, you agree that you have read and understand the Central Michigan Horsemans Assciation Waiver & Release above.

Signature of Member OR parent/legal guardian if member listed is under 18 years of age

Name of person who signed above for waiver/release

First NameLast Name

2026 Central MI Horseman's Association Membership Form