Membership Application

United Rodeo Association, Inc. Membership Application

 3681 NW County RD 16002, Adrian, MO 64720    Date: _____________                   

 Contestant dues $125. - Personnel dues $75. (Secretary, Judge, Contract Act, Announcer, Pick-up men, Clown, Bullfighter, Hazer, Photographer, etc.)
Timer dues $40.   ⬜ Contestant   ⬜ Non-contestant     ⬜ Timer only 

Check one: ⬜ New     ⬜Renewal 

Name_______________________________________________  URA# ___________ 

Address_______________________________________________________________

City___________________________ __State___________ Zip_________  

Phone/Text___________________________ Date of Birth_______________________

Email

Check all that apply:⬜ Bareback  ⬜ Saddle Bronc  ⬜ Ranch Bronc  ⬜ Bull Riding  ⬜ Breakaway  ⬜ Steer Wrestling
⬜ Calf Roping     ⬜ Over Forty Calf Roping     ⬜ Barrel Racing     ⬜ DTR Header     ⬜ DTR Heeler     ⬜ Secretary     ⬜ Timer   ⬜ Judge  ⬜ Pickup Man   ⬜ Announcer  ⬜ Bull Fighter   ⬜ Clown   ⬜ Hazer  ⬜ Other
  Jacket Size____________________ 

Membership becomes effective as of the postmark on the envelope.  If in Over 40 & Open Calf Roping or Breakaway and Open Calf roping designate which for All Around points: _____________________________ 

Applicants under 18 -The following MUST be completed, notarized, & returned to the URA office! Parent/Guardian Consent: I certify that the age & date of birth of the below named child is correct, & I hereby consent to participation of my/our child in the United Rodeo Association, Inc.  I agree that in no event will I hold the URA Inc., its agents, or employees liable for injury or property damage during participation at a URA sanctioned rodeo/event or while enroute to or from a URA sanctioned rodeo. 

Applicant's Name ________________________________ Birthdate_____________ Age_____

Parent/Guardian Signature____________________ _____________________________
(Must be notarized)

The foregoing instrument was acknowledged before me this ________________day of _________________________, 20____________ 

by__________________________________________________________, parent or guardian of the above URA contestant, and I certify that the above information is true to the best of my knowledge

Notary Public_______________________Date________

My commission expires__

1. The U.R.A., its sponsors, rodeo committees, rodeo production entities, Officers and Directors, employees, and agents of such entities, assume no responsibility or liability for injury or damage to the person, property, or stock of any owner, contestant, or assistant, or other claims arising from participation in U.R.A. sanctioned rodeos, including claims that are known and unknown, foreseen and unforeseen, future and contingent. 

Signed:  _______________________________________________________________

    Email: _____________________________________________________________________