Lakehead Light Horse Association 2010

Membership Form
‘Putting the Fun Back Into Horses’

ALL MEMBERS MUST FILL OUT AND SIGN A

MEMBERSHIP FORM

Please print clearly

Membership: Family $30.00_________ Senior $25.00_________ Youth

$20.00___________

NAME:_________________________________________________________D.O.B___________________(Senior
/Youth)

NAME:_________________________________________________________D.O.B___________________(Senior
/Youth)

NAME:_________________________________________________________D.O.B___________________(Senior
/Youth)

NAME:_________________________________________________________D.O.B___________________(Senior
/Youth)
Please attach any additional family members. Seniors may only include
day/month to be included in birthday reminders.

Mailing
Address:_______________________________________________________________________________________

City:_______________________________________________________________PostalCode:________________
________

Telephone:__________________________________
Email:____________________________________________________
(To receive instant
newsletters/updates/notices/reminders/invites)
Please check one:
□ I wish to receive my newsletter by email.
□ I wish to receive my newsletter by mail.

Please check:
□ I have read, and understand the rules stated by LLHA.
□ I request a copy of the rules.
□ I request a copy of the LLHA constitution.

Please check one:

□ I grant my permission for LLHA to publish photos of myself, and/or my family’s in the
newsletter and/or website.
□ I DO NOT wish to have any photos published.

Signature: __________________________________________________
□ I acknowledge that any equestrian event can, and may be dangerous. I accept all risks and
responsibilities for myself, and my family. I do not hold Lakehead Light Horse Association, or
any members, liable for any injury that may occur to me, my family, or my property. I agree to
not make claim against LLHA, and its members, for any injury or damage that may occur.
This must be signed to be a member:

Signature: _____________________________________________ DATE:

____________________________________

Print Name: ____________________________________________

Please make cheque payable to: Lakehead Light Horse Association

Mail to: Box 201, Kakabeka Falls, Ontario, P0T 1W0