Upstate Equestrian
Ministries Fellowship
Application for Membership
206 Adams Mill Road
Mauldin SC 29662
864/288-7458
Name
_______________________________
Address
_____________________________________________________
Home Ph ______________Work
Ph _____________Fax______________Cell Ph_________
E-Mail______________________________________
If completing for family,
note that only immediate family qualify for family status. Include both riding and non-riding members.
Name Relationship Age (if under 16)
_________________________ __________________ __________________
_________________________ __________________ __________________
_________________________ __________________ __________________
_________________________ __________________ __________________
Additional Information:
Area of interest in
horses:______________________________________________________
Area of interest in
Equestrian Ministry:__________________________________________
Would you like to help on
one of our committees?
___Outreach ___Social ___Publicity ___Membership
___Other: ________________
We request a $35 tax
deductible donation for a family membership.
Out of that, $15 pays national dues, $10 pays state dues, and $10 pays
local chapter dues.
Inherent Risk: I
understand that there are inherent risks involved in horseback riding, and
horse related activities. I am fully
cognizant of the risks and dangers and have been informed of known special
hazards of such activity. Therefore, I
assume full responsibility for myself, including my minor children, if any, for
bodily injury, death and loss of personal property and expenses thereof as a
result of those inherent risks and dangers, both identified and not
specifically identified, and of my negligence in participating in horseback
riding and/or horse related activities.
My participation in any and all activities sponsored or promoted by
Equestrian Ministry is purely voluntary, and I elect to participate in spite of
the risks. I have read, understand and
accept these terms and conditions, as is evidenced by my signature below.
Your signature below
entitles you to all rights as a ministry member and signifies your agreement to
abide by all rules and regulations set forth by the ministry.
____________________________________ ___________________________________
Signature Date
______Renewal ______New Member _____Additional
Donations (for bibles, mission
projects, etc.)
_____Amount Given