New______Renewal ______NYPCMS#_______CMSA# _______SASS # _______

Mens _______ Ladies________ Junior_______ Senior _______ Wrangler ______

Name____________________________________________

Date of Birth ________________

Address____________________________________________________________

Town  __________________________  State__________  Zip_________

Phone   ( ___)__________      Cell  ( ___  )______________

*email ______________________  (most info is shared with you this way)

 Individual Membership: $25.00 _____          Junior Member 12-16: $15.00  _____

Wrangler u/12: $15.00 _____      Associate Member: $15.00 _____

Family Membership: $40.00 _____

* Please fill in separate form for each family member

As a member you will receive a newsletter and match results, plus advance notice of upcoming shoots. You are able to vote at club meetings. You will enjoy the sport and help promote gun safety as well as being part of a family sport.

Family Membership - Those persons living under the same roof in a spousal relationship and/or their children under the age of 21 who are still enrolled full time in school.

To be eligible for awards and “move-ups” you must also be a member of the National CMSA.

Liability Release Form:

I understand that I am participating in a sport, which contains dangers, and risks may arise, including, but not limited to, accidental injury, the forces of  nature and illness. In consideration of the right to participate in these events and the services provided for me by the New York Peacemakers Cowboy Mounted Shooters or Cowboy Mounted Shooting Association and its agents, I have and do hereby assume the risks associated with such events. The contestant shall at his own expense, defend management and/or all sponsors, their members, or employees from any and all such claims and indemnify, from any and all liability, damage and costs arising from injuries to person or property occasioned by any act or omission of the contestant.

Signature of Applicant Required  _________________________________  Date ___________

Parent/Guardian if under18 _____________________________________  Date ___________

MAIL TO:   NY Peacemakers, Cowboy Mounted Shooters
                    PO Box 1312
                    Margaretville, NY 12455