July - California Gymkhana Association

CGA MEMBERSHIP
APPLICATION
Office Use Only:
Effective Date: ________
New ____ Renew _____
CGA Year End
Awards Application
1. Only CGA members are eligible. This program is explained in sections 3 and 4 of the CGA Information
Fees: Individual - $ 25.00, Family - $ 50.00, Upgrade - $ 25.00
New ____ Renewal ____ Family Upgrade ____
Date: _____________
# _________ Name: __________________________________________ Birthdate: ____________________
Mail Address: __________________________________________________________________
City: ____________________________________________ State: ______ Zip: ____________
and Regulations.
2. Fees may be transferred to a different mount, but times may not be transferred and Fees are not
refundable should you fail to achieve enough rides to earn an award.
3. The CGA Season begins with the first sanctioned show after State Championship Finals and ends with
the last ride of State Championship Finals the following year.
Any CGA Year End Awards Application will count only shows beginning 60
days prior to the Postmark date until the end of the show season.
Telephone: (_______)_____________________________
Member # ________________________ Date _______________
# _________ Member 2 Name: _______________________________________ Birthdate: _______________
Rider Name ______________________________________________________________________
(This is the name that will appear on the jacket)
# _________ Member 3 Name: _______________________________________ Birthdate: _______________
# _________ Member 4 Name: _______________________________________ Birthdate: _______________
# _________ Member 5 Name: _______________________________________ Birthdate: _______________
Horse or Pony Name: __________________________________________
If this request is for a pony , attach a copy of current CGA Pony Certificate.
This application will be processed as a horse without it.
# _________ Member 6 Name: _______________________________________ Birthdate: _______________
Address _________________________________________________________________________
# _________ Member 7 Name: _______________________________________ Birthdate: _______________
City ________________________________ State _____ Zip _________ Phone _______________
Fee: $ ____________
Method of Payment (check one): Check # ________ Cash: ________ M/O ____________
Visa ____ Mastercard ____ Credit Card #: _________________________ Expires ___/_____
Authorized Signature _________________________________
CREDIT CARD PAYMENTS ARE ONLY ACCEPTED AT STATE OFFICE NOT AT DISTRICT SHOWS.
Signature _____________________________________
(3 rides per event) Fee: $35.00
Year End Awards Level 1
Silver Buckle Silver Breast Collar Set
(Circle one)
(5 rides per event) Fee: $40.00
Year End Awards Level 2
Membership in the California Gymkhana Association gives members the following:
1. CGA Information Manual and CGA Rule Book.
2. Opportunity to sign up for CGA Year-end Awards programs.
3. Opportunity to vote for CGA programs and policies.
Silver Bridle Set
Silver Bracelet
RELEASE OF LIABILITY: The California Gymkhana Association and cosponsoring organization, if any, will not be responsible for any accident that may occur
to be caused by any equine competing at any show or for any article of any kind or nature that may be lost or destroyed or in any way damaged. Each competitor
will be responsible for any injury that may be occasioned to any person or animal or damage to any property while on the grounds by any equine owned, or in
his custody, control and shall indemnify and hold harmless the California Gymkhana Association, it's officials and directors individually and collectively and
cosponsoring organization, clubs and arena owners, if any, from and against all charges and expenses of every kind and nature whatsoever arising out of or which
may be incurred by reason of any accident, injury, or damage to person or property caused by the ownership, competition or custody or control of any animal
competition, In signing this release, please bear in mind that Gymkhana is a contest of speed, that there is a certain element of danger involved and that you will
be riding at your own risk. CGA requests that it’s members wear approved safety helmets. If you choose not to wear a safety helmet, then you as an ider adult r
will accept full responsibility for yourself for any injury which may result from that act when riding in any CGA sanctioned ow. Effective sh March 1, 2003,
all riders under 18 are REQUIRED to wear a helmet when riding at a CGA sanctioned show.
CGA DOES NOT PROVIDE MEDICAL INSURANCE FOR IT’S MEMBERS!
(Circle one)
(Jacket) (minimum 3 rides in 7 events)
(Fee includes Level 1 Award) Fee: $ 120.00
-----OR----- (Fee includes Level 2 Award) Fee: $ 125.00
-----OR----- (Fee includes Level and 1 Level 2 Awards) Fee: $140.00
(Circle one)
Top Rating Award
MUST BE SIGNED !!!
(Please circle one size)Men’s Adult - Small, Medium, Large, X-Large, XX-Large
Youth - Small 6-8, Medium 10-12 or Large 14-16
(Circle one)
Figure on back _____ Male _____ Female (default)
I certify that I have read, understand and agree to the above: Signature _________________________________
(Parent or Guardian if under 18)
Mail to: CGA, PO Box 1746, Gilroy, CA 95021 831-623-9026
Cash ______ Check # ______ Money Order # ______________________
Mail this application with check or Money Order : to
CGA State Office • PO Box 1746 • Gilroy, CA • 95021-1746
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