september 2004 - Dallas Dressage Club

The Dallas Dressage Clubwww.dallasdressage.org~2005~ Membership ApplicationThe DDC membership year is from January 1 – December 31. DDC members receive club benefits which include subscriptionto the monthly newsletter “Transitions” as well as Group Memberships (GM) of the United States Dressage Federation (www.usdf.org)Membership Type: Individual ($40.00) Family ($45.00) Junior ($25.00)Junior members may not reach their 22 nd birthday duringCalendar year 2004 (ref USEF Art 1919, e.)Application Type: New RenewalApplicant InformationName_______________________________________________________________ Date of Birth ______/______/_______Circle one: Dr / Mr / Mrs / Ms / Miss mmm dd yyyyAddress: ________________________________________________________________________________________________City: _________________________________________________________ State: __________ Zip: _____________________Home Phone: _____________________________________ Cell Phone: _______________________________________Work Phone: ______________________________________ Fax: ______________________________________________Email: _________________________________________________I prefer an electronic newsletter via email: YES NOMembership Directory Category: Full [name, address, phone, email listed] Limited [name, city, state] Name Only None [not listed in DDC directory]The DDC may release my address for selected mailings ? YES NOAdditional Family Member IF APPLICABLE. MAY OBTAIN AN USDF GROUP MEMBERSHIP FOR AN ADDITIONAL $17.00 IncludedName__________________________________________________________________________________ Date of Birth ________/________/_________Circle one: Dr / Mr / Mrs / Ms / Miss mmm dd yyyyAddress: ________________________________________________________________________________________________________________________City: __________________________________________________________________ State: __________ Zip: __________________________Home Phone: _______________________________________ Cell Phone: _______________________________________Work Phone: ________________________________________ Fax: ______________________________________________Email: ______________________________________________________________________Family Additional members will be listed as Name Only in DDC directory.Volunteer Opportunities Will you donate some time to club activities? Please check any areas where you would like to volunteer:SHOWS: Scribe Announcer Steward Gate Keeper Scorer Hospitality Assistant Mgr or Secretary Photography VideoTaping Public Relations Phone Committee Fund Raising Publications Event Planning Other _________________________________________________________________________** Volunteer hours are a requirement for 2005 Year End Awards and Scholarship Program **Demographic Survey Please check all that apply.I compete at schooling shows, recognized shows, Neither Number of Horses: _________Dressage Level of Rider: ______________________________ USEF Status: Amateur Junior ProfessionalAdditional Comments _________________________________________________________________________________________________________________________________________________________________________________________________________________Liability ReleaseI hereby release the Dallas Dressage Club, Inc., its officers, members, employees, and agents from any liability and all claims of every kind (including costs,expenses, or attorney fees) that might result from damages, injuries or losses to my person or property during, or in connection with, any show, clinic, event or function, whether or notsuch damages, injuries, losses result directly from the negligent act of omissions of the officers, members, employees, or agents of the Dallas Dressage Club, Inc.Signed ___________________________________________________________________________ Date ____________________(if under 18, must be signed by parent or legal guardian)Return application and check made payable to “DDC” to:Susan Sturdivan Brownlee – DDC Membership ChairPO Box 850727, Mesquite, TX 75185-0727Questions? Contact Susan Brownlee, membership@dallasdressage.orgor 972-226-0366 (h)DDC Office Use OnlyCheck # ____________ Amount: $__________ Date: ___________Date Rec’d ________________ DDC ID # _______________db_________ ver ltr_________ USDF_________ Horse reg # __________