2012 PBR Membership Requirements - Professional Bull Riders

PROFESSIONAL BULL RIDERS, INC.
2012 Membership Application
This application must be filled out completely, signed and submitted to Professional Bull Riders, Inc. (“PBR”), 101
West Riverwalk, Pueblo, CO. 81003. Phone 719-242-2800 / Fax 719-242-2767 before membership will be considered.
MUST SEND COPY OF DRIVER’S LICENSE or other valid government issued PHOTO IDENTIFICATION.
Office Use Only
ID #: _____________ Paid: _______
Name:
_______________________________________________________________________________
Last First Middle Ride As:
Address: Physical Address: (For express mailing – UPS,
FedEx)
___________________________________ ____________________________________
Street, RR or Post Office Box Street
___________________________________ ____________________________________________
City State Zip City State Zip
Hometown City and State (if different than mailing address): __________________________________________________
Preferred Method to Receive Information: ______ Email
______ Regular Mail
Phone Number: ______________________________ Fax Number: ________________________________
Cell Phone: __________________________________ E-Mail: ______________________________________
Social Sec. #: __________________________ (Please include a copy of your Social Security Card, Identification Card or Visa)
Birth Date: ________ Height: ________ Weight: ________ Marital Status: ________
Contact in Case of Emergency: Life Insurance Beneficiary:
________________________________ _________________________________
Name Relationship Name Relationship
_________________________________
_________________________________ _________________________________
Street Address Home Phone Work Phone
_________________________________
Home Phone Work Phone
Coat Size: ________ Jean Size: ________ Boot Size: ________ Dress Shirt Size: ________
(This information is typically used for BFT Rider, but would be appreciated for all riders.)
PBR MEMBERSHIP OATH:
I, ______________________________________, hereby acknowledge that PBR membership is an INVITATION ONLY privilege, and NOT A RIGHT,
and that membership may be withdrawn, denied, terminated, suspended or modified at any time, with or without cause, at the sole and absolute
discretion of PBR. I hereby agree to conduct myself in a professional, moral and financially responsible manner or, in the sole and absolute
discretion of PBR, face immediate dismissal, suspension, loss of awards, and/or fines. I agree to be bound by and conduct myself in accordance
with the bylaws, rules, policies and codes of conduct of the PBR which are subject to change and I, for and on behalf of myself and my spouse,
children, parents, next of kin, heirs, representatives, successors and assigns, expressly waive and release any and all claims for personal injury,
death, property damage or any other claim that I have now or may have in the future against the PBR, its parents, subsidiaries, affiliates,
members, shareholders, officers, directors, employees, agents, officials and sponsors, and any PBR sanctioned, approved or affiliated bull riding
production entity and their respective affiliated, associated, related, parent or subsidiary companies. This provision shall be binding upon me, as
well as upon my spouse, children, parents, next of kin, legal representatives, heirs, successors and assigns. I have been repeatedly warned
about the hazards and risks inherent in bull riding, realize that bull riding is an inherently and extremely dangerous event and I understand and
accept those risks. This oath shall be valid and applicable for all future periods of membership even if not resigned each year or each season. I
swear that the information stated above is both accurate and true.
Signature: _____________________________________
Date: _________________________________________