INLAND EMPIRE BARREL RACING ASSOCIATION, INC.

2010 MEMBERSHIP APPLICATION

Members must reside in Spokane, Stevens, Ferry, Pend Oreille, Lincoln, Whitman, Adams,

Grant, Douglas & Okanogan Counties in the State of Washington

And Bonner, Kootenai, Shoshone and Latah Counties in the State of Idaho.

Name:                                                                                                                                                

Address: ______________________________________________ City:                                                               

State/Zip:                                                           Phone:_(______)_____________________

E-Mail                                                                                                                                                             

MEMBERSHIP FEE: INDIVIDUAL $25_____________FAMILY: $35___________

(For award purposes): Belt size:                        Coat size:                               Boot Size:                       

Horse Blanket Size:                       

OPEN DIVISION COMPETITOR: Rider:                                                               Horse:                                                 

LIST NOVICE REGSTRATIONS BELOW:

JUNIOR DIVISION: AGES 12 & UNDER

YOUTH DIVISION: AGES 13-18

IEBRA RELEASE FORM

AS MEMBER OF THE IEBRA, I HEREBY AGREE TO HOLD HARMLESS AND ASSUME THE RISK OF ANY INJURY TO MYSELF, MY PROPERTY AND EVERY MINOR PERSON WHO ACCOMPANIES ME TO AN IEBRA SPONSORED OR CO-SPONSORED EVENT. FURTHER I WILL HOLD HARMLESS EACH EQUINE ACTIVITY SPONSOR FROM ANY CLAIM OF INJURY OR DAMAGE THAT COULD BE SUSTAINED BY MYSELF, MY PROPERTY AND EVERY MINOR PERSON WHO ACCOMPANIES ME TO AN IEBRA SPONSORED OR CO-APPROVED EVENT.

MEMBER SIGNATURE:                                                                          DATE:___                   _______

GUARDIAN:____________________________________________________________

SEND APPLICATIONS TO:

IEBRA SECRETARY/TREASURER