GREAT LAKES TEAM PENNING      ASSOCIATION 989-763-3276 5691 RICH ROAD                      ALMA , MI 48801

2009 MEMBERSHIP# ___________

Membership fees:

•     $15.00 for Individuals, $25.00 for Families
•     This includes a subscription to the GLTPA newsletter.

Make your checks payable to Great Lakes Team Penning Association

PLEASE PRINT NAME(S)

_______________________ SSN# ________________________

_______________________ SSN# ________________________

_______________________ SSN# ________________________

ADDRESS ________________________ PHONE _____________

It is mandatory that you ASWNER THE TWO FOLLOWING QUESTIONS. Please initial after each answer, if more than one person is answering each question.

How many years or months have you been sorting or penning?____________________________________________________

Have you won over $500.00 since your first time sorting or penning?_____________________________________________________

PARTICIPATION IN GREAT LAKES TEAM PENNING ASSOCIATION EVENTS-TERMS AND CONDITIONS:  I HEREBY COVENANT NOT TO SUE AND AGREE TO INDEMNIFY, AND SAVE, AND HOLD HARMLESS “Great Lakes Team Penning Association” its agents, employees, representatives and all others in any way connected with the production and operation of the events and the facilities from any claim, demand, or liability for personal injuries or property damage arising from participation or use and enjoyment of the events and facilities. THE UNDERSIGNED HAVE READ AND VOLUNTARILY SIGN THE COVENANT AND INDEMNITY AGREEMENT, and further agree that no oral representation statement or inducements apart from the foregoing written agreements have been made. I understand that Great Lakes Team Penning reserves the right to refuse participation or to remove any participant at any time in its sole and complete discretion.

SIGNED _________________________________  DATE __________________

SIGNED _________________________________ DATE ___________________

This consent/release must be signed by the parent or guardian for all participants who are minors.

*Your rating will be determined by the Great Lakes Rating Committee.  You will receive your membership/rating card and rules shortly after your membership is accepted.