THIS IS NOT AN ON-LINE SUBMISSION FORM-PLEASE COMPLETE, PRINT THIS FORM AND MAIL

2020 Nebraska 4-D Membership Application

All race information and results will be found on the website  www.ne4d.com.

 

Open 4-D Membership - $30.00 ($35.00 after July 1 of current year)  Eligible to compete in Open Division 

 

 Youth 4-D Membership (13 and under) - $20.00 ($25.00 after July 1 of current year)  Eligible to compete in the Youth

                  Division - must be 13 or under as of the Finals and have made one (1) approved run before 10/1/2020 as a PAID

                  member to compete at the NE 4D Finals

Pee Wee 4-D Membership (7 and uner) - $15.00 ($20.00 after July 1 of current year)  Eligible to compete in the Pee

                  Wee Division - must be 7 or under as of the Finals and have made one (1) approved  run before 10/1/2020 as a PAID

                  member to compete at the NE 4D Finals

 

Nebraska 4-D Release Agreement

By making an application to join the Nebraska 4-D, Applicant agrees to participate at their own risk.  Applicant here by releases and discharges the Nebraska 4-D, its Board of Directors, representatives, employees, and agents for all liability, loss, claims, damages and expenses for injuries to person, property, reputation, or financial condition as a result of, or in any way relation to Applicants participation, or failure to participate, in an Nebraska 4-D event, whether caused by negligence, by arena or facility conditions, by the conduct of show management, or the administration of failure to enforce any Nebraska 4-D rule, regulation, bylaw, guideline, or otherwise.  Applicant further agrees that by signing this application, he/she completely releases the Nebraska 4-D from any liability, including negligence.  Applicant voluntarily chooses to participate and abide by all rules and regulations of the Nebraska 4-D.

 

Signed  _______________________________________________________________ Date _______________             

              _______________________________________________________________ Date _______________

               (Parent or Guardian if applicant is a minor)

 

 Nebraska 4-D Membership Information

 

Name  

Address 

City State

Zip Phone

E-mail    Date

 Are you a

 New Member

 Renewal Member   

 Sex:    M  F   

 For youth:

 DOB

 

ALL APPLICATIONS MUST BE SIGNED AND COMPLETED.

INCOMPLETE APPLICATIONS WILL BE RETURNED.

Send completed application to:

Nebraska 4-D

19972 S 600th St 

Palmer, NE 68864

 

(Tear here to keep  for your records)

 

 

 

Date Joined

 

Name

 

CHECK _____    CASH _____

 

Nebraska 4-D

c/o Rebecca Hodges

19972 S 600th St

Palmer, NE 68864

Board of Directors

Secretary..........Marlene McGaughey (308) 872-6998

Finals/Awards..........Lee Ann Kucera (308) 750-7860

Finals/Membership.........Rebecca Hodges (417) 987-7677

Scheduling/Results..........Beth Baxter (308) 440-3776