Ontario Xtreme Cowboy

OXC 2019 Membership Application

OXC Membership Type

	Amount
Adult OXC Membership (Over 18 years as of January 1st)
Junior OXC Membership (Under 18 years as of January 1st)
Family OXC Membership (2 Adult Memberships and any number of Junior Memberships, living in the same home)
One Day OXC Membership (Used once per calendar year, per person. Any rider points will only be accumulated after a full OXC membership is purchased. If a full membership is purchased, the One Day Membership fee will be applied against the full membership fee.)
Total Amount

Contact Information:

Name

Street Address

City

Province

Postal Code

Phone Number

Choose One:

Junior Date of Birth

Choose One:

Parent or Guardian

Parent or Guardian Phone Number

Adult 1

Adult 1 Division

Only forms that are completed WITH payment will be considered registered. Payment accepted via etransfer to ontarioxtremecowboy2012@gmail.com or by Cheque Payable to: Ontario Xtreme Cowboy Mailed to: c/o Shelley Newton, 493 Islandview Road, Roseneath, Ontario K0K 2X0

By checking this box off I have read, acknowledged and accepted these terms as outlined by OXC here as the applicant or guardian.

I/we hereby agree to abide by the constitution, by-laws and rules of OXC. OXC assumes no responsibility in cases of loss, damage or injury to persons, horses, or personal property from any cause and/or from any condition. Unless otherwise specified, members agree to allow the use of photos capturing them at OXC events for OXC promotional purposes such as newsletters, social media, media coverage, or sponsorship, without further compensation. Parental/guardian permission will extend to youth members.  Upon this signed agreement only are memberships accepted.

For general inquiries email: ontarioxtremecowboy2012@gmail.com