Membership Application – The Gypsy Horse Registry of America, Inc

Instructions Welcome and Thank YOU for joining the Gypsy Horse Registry of America, Inc. Please enter all the information below. Upon completion this form will go directly to Paypal for payment. There is a $5.00 postage fee added in the total. Once again Thank You!

Name *

Spouse's Name

Address *

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Phone *

Email *

Website Address

Ranch/Farm Name

Membership Requested

Please click the option that is most appropriate for your membership. Prefix/Suffix Fee - The fee to register a Prefix or Suffix is $100.00 and is a one time only fee. No punctuation allowed.Lifetime 700Annual 75(horse owners)Associate 50 (non horse owners only)Youth 20

Voting *Select if yes or no if you would like to be a voting member. Only Lifetime, Annual and International Members have the option to vote.

Breeders List *

If you own more than one Section A or B Gypsy Horse, registered with the GHRA, you are welcome to have your farm/ranch published in the Breeders List. Would you like to be included in a published Breeders list?YesNo

Other Registries or Clubs (Optional) Do you belong to any other registries or clubs, if so which ones?

Youth's Full Name

Youth Date of Birth

Address

Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Release of Liability: This Release of Liability is made and entered into on this day forward by and between the Gypsy Horse Registry of America, Inc. herein designated GHRA, and the above named applicant/applicants herein after designated as a member of the GHRA and if member is a minor, his or her parent or legal guardian return for use today and on all future dates of any property, facility or services of or used by the GHRA. The GHRA member, his heirs, assigns and legal representative expressly agree to the following: GHRA member agrees to assume ANY AND ALL RISKS INVOLVED IN OR ARISING FROM ANY GHRA ACTIVITY including, without limitation but not limited to, the risks of death, bodily injury, property damage from falls, kicks, bites, collisions with vehicles, horse(s) or stationary objects, fire or explosion, the unavailability emergency care, or the negligence or deliberate act of another person. It is the responsibility of GHRA member to carry full and complete insurance coverage on his horse(s), personal property and himself/herself. WARNING: Under Texas Law (chapter87, Civil practice and remedies code), an equine professional is not liable for an injury or the death of a participant in equine activities resulting from the inherent risks of equine activities.

GHRA Member Electronic Signature or Guardian Signature *By placing my name above I agree to all terms and conditions on this form.

Date *

GHRA Membership Form

Youth Applicaiton

Thank You!