OCTRA Membership Form 2012

Are you a returning member?

New
Renewal

If new, how did you hear about OCTRA?

Friend
Website
Clinic
Other:

First Name

Last Name

Street Address

City/Town

Province

Postal Code

OCTRA Membership # (for renewing members)

OEF Membership #

Phone Number

Email Address

First Name of Second Adult Family Memberships Only

Last Name of Second Adult Family Memberships Only

Second Adult OCTRA Membership # Family Memberships Only

Second Adult OEF Membership # Family Memberships Only

Membership Type

Junior $25 (under 18 on Dec 31 2012. Not entitled to vote.
Adult $45 (individual over 18 years of age)
Family $60 (two adults in one household & unlimited juniors under 18
Associate $35 (individual, no vote, not eligible for awards)
Replacement card $5 (fee waived for old/damaged cards if returned)
Postal delivery of the Pulse $15

List of Juniors Please list all Juniors, date of birth of each, OCTRA and OEF membership numbers

Photo Release Agreement I hereby give OCTRA the right to use photographs taken of me for publishing, illustration, advertising, trade, or any other use in any medium for any purpose. I release OCTRA from any claims and demands coming out of the use of the photographs, including any claims for libel. This release also covers OCTRA’s legal representatives and any licenses of these photographs.

I accept agreement
I decline agreement

Liability Release Agreement I agree to abide by the rules of OCTRA and/or AERC and /or Equine Canada. I understand that distance riding involves being in remote areas for extended periods of time, far from communication, transportation and medical facilities; that these areas have many natural and man made hazards which can include unpredictable weather conditions, which ride managers cannot anticipate, identify, modify, or eliminate; that horses can be excitable, difficult to control, unpredictable; that accidents can happen to anyone at any time. I agree to take full responsibility for myself and the animal that I am riding. I will hold the ride management, all rider personnel and all property owners, over whose land the ride crosses, blameless for any accident or loss that might occur due to my participation in the ride, and free from liability for such injury or loss.

I have read and understand this Liability Agreement

Does OCTRA have permission to publish your name, address, email and phone annually in our membership directory? Signature of parent/guardian of juniors will be required on a paper copy of form... please mail to the Membership Secretary

Does OCTRA have permission to contact you in relation to volunteering at our events? Signature of parent/guardian of juniors will be required on a paper copy of form... please mail to the Membership Secretary

I understand that the signature of a parent/guardian of juniors must be mailed, or scanned/emailed to the membership secretary Misha Green, Membership Secretary 41 Briarwood Road, Unionville, ON L3R 2W7 Phone 905-475-9466 email: mishagreen@rogers.com

Signed form will be provided