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One entry per rider.
Please provide Bio on separate sheet.
Name______________________________________________________________________
Address
____________________________________________________________________
City __________________________________ State
______________ Zip _______________
Home Phone _________________________ Cell
Phone ____________________________
E-mail _________________________________
Horse’s Name ______________________
CMSA # ____________________________ Class
Level ________________
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Adults & Juniors
$175 (postmarked by OCTOBER
21st) |
$____________ |
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Wranglers $50 |
$____________ |
Cowboy Corral
Eliminator
1's $20, 2's $40,
3's $60, 4's $80, 5's $100,
6's $120 |
$____________ |
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Rifle Shoot
$30 (one stage) |
$____________ |
Stalls $15 per/Night
Prepaid only (Porta-Pens are NOT allowed)
Number of Horses _____ X
Nights Staying _________ |
$____________ |
Dinner on Saturday
$20 (per person) Number
of Dinners _________ X $20
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$____________
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Make
checks payable to: ACMSA
Total Enclosed |
$____________ |
Disclaimer and Release of Claims
I, the undersigned, understand that I am participating in this
sport, which contains serious dangers and risks, however unforeseen
that may arise. I also fully understand that those dangers and
risks include, but are not limited to, persistent vegetative state,
total and/or partial paralysis, death, a variety of orthopedic
injuries, both permanent and otherwise, and other accidental
injuries through the forces of nature and/or illness. In a
consideration of the right to participate and compete in these
events and other items provided to me by the Cowboy Mounted Shooting
Association, Inc. (CMSA), its shareholders, officers, directors,
employees and agents, by my signature below, I hereby freely and
voluntarily assume the above noted Application/Entry From to
carefully read its contents, I understand the nature and scope of
the risks I am assuming and hereby release and discharge CMSA, its
shareholders, directors, officers, employees and agents from any and
all liability in the event I sustain an injury at a competitive
event or otherwise. I further agree at my expense to indemnify and
hold harmless CMSA, its shareholders, directors, officers, employees
and agents and/or all sponsors and their shareholders, directors,
officers, members, employees and agents from any and all claims made
arising from any such injury, including claims for damages and
attorney fees.
Signature_______________________________________________ Date
___________________
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