THIS IS NOT AN ON-LINE SUBMISSION FORM-PLEASE COMPLETE, PRINT THIS FORM AND MAIL
2018 Nebraska 4-D Membership Application
One membership form must be completed for EACH member
All race information and results will be found on the website www.ne4d.com.
If you do not have internet you can receive a monthly mailing from April-October
Open 4-D Membership - $30.00 ($35.00 after July 1 of current year)
Eligible to compete in Open Division.
Family 4-D Membership - $20.00 per additional person ($25.00 after July 1 of current year)
(Must have one full paying Open Membership, then each additional family member, residing at the same address,
qualifies for the rate. Open Division Eligibility.)
Pee Wee/Youth 4-D Membership - (13 and under) - $15.00 ($20.00 after July 1 of current year)
(Eligible to compete in the Youth Division.)
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, it’s 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
ONE MEMBERSHIP FORM MUST BE COMPLETED FOR EACH MEMBER.