BACKCOUNTRY HORSEMEN OF WASHINGTON, INC

Cascade Horse Club Chapter

P O Box 1359, Lake Stevens WA 98258

I would like to help preserve the Horsemen's rights to use horses on public land. (rev9/04)

PLEASE PRINT CLEARLY

State Membership For The 2006 Calendar Year

New

Renewal

Name(s)

"Family" Membership

$35

"Single" Membership

$26

Address

Additional State Donation

***** OR *****

Optional Memberships:

"Contributing"

$50

County

Legislative District

"Sustaining"

$100

"Patron"

$250

Phone

"Benefactor"

$500

If NOT paying state dues, please note which chapter

they have been p

LIABILITY RELEASE

*** PLUS ***

CHC Chapter Dues

$10

MUST BE SIGNED BY ALL MEMBERS

Total Enclosed

Recognizing the fact that there is a potential for an accident where ever horse use in involved, which can cause injuries to horses, riders, and spectators

and also recognizing the fact that Backcountry Horsemen of Washington, Inc., including chapters, officers, directors, or members cannot

always know the condition of trails or the experience of riders or horses taking part in Trail Rides or other BCHW function. I do hereby release the

above named from any claim or right for damages which might occur to me, my minor children or horses.

Signed

Dated:

Signed

Dated:

Signed

Dated:

Signed

Dated:

Dues are not deductible as Charitable Contributions for Income Tax Purposes. Dues may be considered ordinary and necessary business deductions.

Please Note: Membership Dues Must be Paid By March 1

To Continue to Receive CHC Newsletter

and Trailhead Newsletter

How to contact us by mail:

Cascade Horse Club

PO Box 1359

Lake Stevens, WA 98258

info@cascadehorseclub.org