BECOME A MEMBER
OF THE
NATIONAL COWBOY CHALLENGE ASSOCIATION
THROUGH MY AFFILIATED CLUB

(pro rata membership fees apply July 1st - 31st December)

MEMBERSHIP APPLICATION FORM

First name

Last name

Street Address

City

Region/State/Province

Postal / Zip code

Phone

Date of Birth

AFFILIATED CLUB NAME

Emergency Contact Name

Emergency Contact Number

Known Medical Conditions

Rider Level & Experience

Photo Release – When participating in NCCA events you or your child/children may be photographed or filmed. NCCA may use these images for promotional use, this includes but is not limited to, use on the NCCA website, marketing material and in all forms of media. by leaving this box unchecked I give consent.

I DO give consent

I do NOT give consent

I accept the terms & conditions of Membership attached

I hereby apply for membership of the NCCA. In doing so I so agree to be bound ..by the terms and conditions outlined on the attached terms and condtions as well as all decisions made by the NCCA Board of Directors. PLEASE SIGN BELOW

Select an item (AU$)

Adult Membership Through Affiliate - AU$65.00

Child Membership Through Affiliate - AU$45.00

Thank you for submitting your Member Form

Your Membership Payment is to be made through your affiliated club

BECOME A MEMBER OF THE NATIONAL COWBOY CHALLENGE ASSOCIATION THROUGH MY AFFILIATED CLUB

(pro rata membership fees apply July 1st - 31st December)

MEMBERSHIP APPLICATION FORM

BECOME A MEMBER
OF THE
NATIONAL COWBOY CHALLENGE ASSOCIATION
THROUGH MY AFFILIATED CLUB