BACK COUNTRY HORSEMEN OF OREGON, INC.
Columbia Gorge Chapter BCHO
20010 Membership Application

New____ Renewal____


1.____________________________________________ Family Single
Print Name State Dues $ 22.00 $ 15.00
2.____________________________________________ Nat’l Dues $ 8.00 $ 5.00
Print Name Chapter Dues $ 10.00 $ 10.00
__________________________________________________________________ Total $ 40.00 $ 30.00
Address
__________________________________________________________________ (Not tax deductible)
City State Zip
_____________________________________________________ Make checks payable & mail to:
E-mail address Phn. #
Columbia Gorge Chapter BCHO
P.O. Box 494
Odell, OR 97044

Liability Release: Recognizing the fact that there is a potential for an accident whenever horse use is involved, which can cause injuries or death to riders, horses and spectators,
and recognizing the fact that Back Country Horseman of Oregon, Inc., chapters, officers, members and guests cannot always know the condition of trails or the experience of rider
and horses taking part in trail rides or other BCHO functions, I do hereby release the aforementioned named from any claim or right for injuries, death and damages which might
occur to me, my spouse, minor children, livestock, and property.

Signed____________________________________Date ______Signed__________________________________Date_________
Must be signed by all chapter members 18 years and older.