Atlantic States Gay Rodeo Association

Membership Application

This form is for New and Renewal Memberships via Credit Card only.
To pay by check please use the printable form

Please make sure your e-mail address is correct. You should receive a conformation e-mail within 48 hours, if not please contact us at
Red fields must be completed

New member	Renewal Membership #

Full Name (first last)
Birth date (MM/dd/YYYY)	(optional)
Alias
In the ASGRA newsletter you may print:	My full name My first name & last initial My alias Do not print my name
Home Phone
Work Phone
Address: Street
City
State
Zip
Your E-mail Address:

HomoRodeo.com profile name will receive a free 1 month Gold membership

All ASGRA memberships run from January 1st through December 31st.

Regular	$ 30
Family	$ 55 (2 people living at the same address)
Silver Spur	$125
Business	$200
Golden Saddle	$425
Lifetime	$600

Fill in this part ONLY if you are applying for a Family Membership enter the following for the Second Person
Second Person's Name
Second Person's e-mail
You may print in the newsletter:	My full name My first name & last initial My alias Do not print my name
Birth date (MM/dd/YYYY)	(optional)

By submitting this application I hereby agree to the following:

To conform to the bylaws, standing rules and any other rules adopted by the Board of Directors or other officials of ASGRA.
To comply with all applicable laws when participating in or attending any ASGRA sponsored event.
To pay any of my required ASGRA or IGRA dues or assessments on time.
To not hold ASGRA responsible for damage, injury, liability or death, to me or my property while in preparation for, during, or immediately following any ASGRA sponsored function which I attend. This affirmation includes me, my executor, administrator, and assigns.

I understand that failure to follow these rules may result in termination to my membership

Check this box to indicate that you agree to the above
AND that you are 18 years of age or older
You cannot proceed without checking this box.

Double check your entries first
There is no conformation screen after you click submit

Click the Home button at top of page to cancel

Last update
Jan 20, 2020