Membership Form

First Name(Required)

Last Name(Required)

Spouse/Partner First Name

Spouse/Partner Last Name

Email Address(Required)

Email Opt-In(Required)

Yes

SJBCH may use my email address and/or phone number for member-use contact information.

Phone

Street Address(Required)

City(Required)

State/Province(Required)

Zip/Postal Code(Required)

Country(Required)

Referred by

Member Status(Required)

New Membership

Renewal Membership

Membership Type(Required)

Family Membership-$50

Individual Membership-$45

Multiple BCH -$20 (provide proof of your parent-unit BCH membership)

I'm interested in donating time to:(Required)

Trail Projects

Social Rides

Education: Meetings/Clinics

Fund Raising

Newsletter Assistance

Administrative

Other?

What other areas would you like to participate in?

Enter your initials to accept disclaimer(Required)

I am aware that the activities involving horses can be inherently dangerous and hazardous, and thereby agree to accept any and all risks of injuries or death that may be associated with participation in events sponsored by the San Juan Back Country Horsemen. I (we) hereby release the San Juan Back Country Horsemen, each and every member, officer and director, agent, employee of any and all liability, which may be sustained in connection with the chapter’s activities pursuant to section 13-21-119, Colorado Revised Statutes.

Signature(Required)

Typing your name(s) will serve as your signature.

Date(Required)

Spouse/Partner Signature

Typing your name will serve as your signature.

Date

Payment Method(Required)

Online with credit card

I will mail a check

Payment Method

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.