Application Form

             Back Country Horsemen of Missouri

                            Printable Version                                       

                       Membership Application

 Name__________________________________________

Address________________________________________

City/State/Zip____________________________________

Telephone______________________________________

Email__________________________________________

Referring Member *________________________________

Please check One:

___  Individual-$40.00

___  Family-$45.00

___  Club or Business Membership-$60.00-entitles you to business card ad in quarterly newsletter and link on website.

New Member joining after August 1st will receive the rest of that year and the following year for one year’s membership fees.

 Members may be a Chapter member or a member At Large, the dues are the same.  Please indicate your chapter affiliation if applicable:

___  Brownfield Chapter – Lebanon/Waynesville area

___  Cuivre River Chapter – Troy area

___  Eastern Missouri Chapter – Desoto, Farmington area

___  Heartland Chapter – Fayette, Columbia, Boonville

___  Indian Trails Chapter – St Clair area

___  Mountain Riders Chapter – Ava area

___  Nemo River Valley Chapter – Monroe City area

___  River Springs Chapter – Winona, Van Buren area

___ South Central Chapter – Rolla, Salem, and Licking Area

___ State Fair Trails Chapter – Sedalia area

___  Tri-Lakes Chapter – Springfield, Bolivar, Marshfield area

___  At Large – (meaning you do not belong to a specific Chapter)

Make check payable to: Back Country Horsemen of Missouri (BCHMO)

Mail application to: Karen Mertz  1068 Highway 68  Salem, MO 65560 or

call 573-247-6922 or send to mertzinoz@aol.com

By joining BCHMO, I agree to hold harmless the Back Country Horsemen of Missouri organization, its directors, officers, and members from any and all liability, claims or demands for personal injury, sickness or death, property damages and expenses incurred by myself or family member while participating or attending a BCHMO event except in the event of gross and willful negligence.

INCENTIVE PROGRAM:      Recruitment Incentive