Professional Senior Rodeo Association
2021-22 Membership Form
ONLY ONE MEMBERSHIP PER FORM.
PLEASE DOUBLE CHECK YOUR MATH
Please make your checks to the PSRA and mail
1477 Hwy 201
Adrian, OR. 97901
Feel free to call at 208-250-6361 if you need assistance.
Social Security Number
Address Line 2
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Saint Kitts and Nevis
Saint Vincent and the Grenadines
Trinidad and Tobago
Bosnia and Herzegovina
United Arab Emirates
Papua New Guinea
Central African Republic
Democratic Republic of the Congo
Republic of the Congo
Sao Tome and Principe
United Republic of Tanzania
Country / Region
Date of Birth
EARLY BIRD MEMBERSHIP IS DUE BY FEBURARY 28, 2022
Early Bird Membership $150.00
Permit ( Three Per Season) $25.00
Stock Contractor $50.00
How Long Have You Rodeoed
List each, a description, the level, and number of years of involvement.
Other Activities You Enjoy?
List your organizations, position, description of the activities you are involved in other than rodeo.
May we publish your information for a membership directory?
Would you like to donate to the crisis fund?
Would you like a monthly copy of the Rodeo News?
Do you understand and agree to the terms listed above?
Yes, I understand and agree to the terms listed above.
One Time Office Fee
THIS IS A RELEASE OF LIABILITY. BY BECOMING A MEMBER OF THE PSRA, YOU ARE AGREEING TO RELEASE ALL PARTIES FROM LIABILITY. PLEASE READ THIS PROVISION CAREFULLY. Members acknowledge that rodeo events, including PSRA-sanctioned events, are inherently dangerous activities. Members further acknowledge that participation in a PSRA-sanctioned event (whether as a competitor, independent contractor, official, laborer, volunteer or observer) exposes the participant to substantial and serious hazards and risks of property damage, personal injury and/or death. Each Member, in consideration of his membership in the PSRA
and his being permitted to participate in a PSRA-- sanctioned event in any capacity, does by such membership and participation agree to assume such hazards and risks. Each Member further agrees to discharge, waive, release and covenant not to sue PSRA , all A sponsors, all Members (including, without limitation, contestants, stock contractors, Rodeo Committees, Rodeo Producers and Contract Personnel), and any other PSRA- sanctioned event production entity (and each party’s respective officers, directors, employees and agents), from all claims, demands and liabilities for any and all property damage, personal injury and/ or death arising from such Member’s participation in a PSRA-sanctioned event. This discharge, waiver and release includes claims, demands and liabilities that are known or unknown, foreseen or unforeseen, future or contingent, and includes claims, demands, and liabilities arising out of the negligence of the parties so released by such Member. Furthermore, where permitted by applicable law, this discharge, waiver and release also includes claims, demands and liabilities arising out of the gross negligence or willful and wanton negligence of the parties so released. This discharge, waiver and release also includes claims, demands, and liabilities by a Member for indemnities and contributions arising from property damage, personal injury and/or death to a third party. In the event that any provision of this discharge, waiver and release is determined to be invalid for any reason, such invalidity shall not affect the validity of any of the other provisions, which other provisions shall remain in full force and effect as if this discharge, waiver and release had been executed with the invalid provision eliminated. The undertakings and covenants of the foregoing provisions shall be binding upon each Member, his or her heirs, legal representatives, successors, and assigns. Each Member (including, without limitation, contestants, stock contractors, Rodeo Committees, Rodeo Producers and Contract Personnel) agrees to indemnify and save and hold harmless PSRA, and all PSRA sponsors from any and all claims, demands and liabilities for any and all property damage, personal injury and/or death asserted by a third party (defined as any party other than the Member , PSRA sponsor) and arising from such Member’s participation in a PSRA-sanctioned event.
I understand above information