Membership Application
1. I hereby apply for new membership or membership renewal in the New England Amateur Harness Drivers Club, Inc. (NEAHDC), and pledge myself to abide at all times by the rules and regulations of The United States Trotting Association and the NEAHDC.
2. In making this application I acknowledge that I have knowledge of harness racing activities, and realize the inherent dangers involved in training and racing harness racehorses, and realize that other significant and unanticipated dangers may arise. I hereby voluntarily release the NEAHDC from any loss, liability, damages or cost arising out of or resulting from this application being approved and my engaging in training and racing activities. I hereby waive any claims or demands of whatever nature, which I or my heirs or administrators have or may have against the NEAHDC arising out of or resulting from this application being approved and my engaging in training and racing activities. I willingly and fully assume the risk for injuries or any other losses arising out of or resulting from my engaging in training and racing activities.
3. The NEAHDC Membership dues must be included with the application (will be fully refunded if the application is not approved). Yearly renewal membership dues are due on April 27, 2017. Membership dues are $25 and must be paid prior to their first race.
*Print Name: __________________________________________________________
*Address: __________________________________________________________
*City: __________________________________________________________
*State: ___________________________ *Zip Code: _________________
*Email: __________________________________________________________
*Telephone (day & evening): _____________________________________________
*Date of Birth:_______________________________ ___________________________
*USTA Membership Number: ________________ ___________
1 (over for page 2)
*If you are a licensed USTA Driver, Type of License: P A
Driving Colors: __________________________________________________
Program Weight:_________________________________________________
If you are a licensed USTA Trainer, Type of License: L G
Please summarize your harness racing experience:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________
Signature: ________________________________ Date:_________________
Please forward this application and membership dues to:
New England Amateur Harness Drivers Association
Attn: President, Bill Abdelnour
301 Washington St
Plainville, MA 02762
* Required information
2
Share with your friends: |
