Florida Whips, Incorporated Membership/Release Form

Name:___________________________________________________________New ______ Renewal _____
First Middle Initial Last
Names of adult participating family members at the same address: _____________________________________

Names of participating family members under 21 __________________________________________________

Farm Name: ________________________Address: ______________________________________________

City:_______________________________________State _________Zip Code _______________

Home Phone:(____)____________ E-mail address:_______________________________
How many years have you been carriage driving_____________

I am also a member of (check all that apply)
American Driving Society Carriage Association of America	USA Equestrian (formerly AHSA) Other Carriage Driving/Equine Organization (please specify) _________________________________

I am most interested/participate in the following carriage driving activities:
Combined Driving Events (including Arena Driving and Driving Trials) Driven Dressage Pleasure Driving Competitions (including Traditional Drives, Turnout, Ring Classes	Trail Driving (including camp outs, pace events, and day distance trips Fun Show Competitions (non-rated) Volunteering at events Clinics/General Equine Education
Would you like to be included in the Whips directory (for member use only)? Yes No

Florida Whips, Inc. maintains the privacy of its members, and does not sell your information for commercial purposes. Your contact information can be made available to other Florida Whips Members. However, on occasion the Florida Whips are contacted by other carriage and equestrian organizations to provide information about their events. Would you like your information released to such organizations? Yes No

RELEASE STATEMENT WARNING

I am aware that under Florida Law, an equine activity sponsor or equine professional is not liable for injury to, or the death of, a participant in equine activities resulting from the inherent risk of equine activities. This document is meant to be a full, and complete release from any and all liability that may arise from participating in Florida Whips equine activities. This release is given freely and voluntarily by the participating members and is meant to remain in existence throughout the duration of the membership.

SAFETY RULES OF THE FLORIDA WHIPS
	Vehicles and harness must be serviceable, and in good repair. Horses must have bridles on with reins attached prior to hitching to a vehicle. Vehicles must be unhitched prior to removing reins and bridles. Never tie a horse or leave it unattended when hitched to a vehicle. Driver must have a whip. Never pass another carriage at a fast trot or drive too close to another carriage.

Signature:________________________________________________________ Date________________

Signatures of Other Family Members:_________________________________________________________
Dues are $30 per year, and the membership year begins September 1.New Memberships received after April 1 will be good until September of the following year. Please make checks out to Florida Whips, Inc. and return with this form to: Francine Arrington, 4200 Alan Shepard Ave., Cocoa FL, 32926

05/2006