Tejas Caballeros

Membership/Renewal Application and Liability Release

Print/Complete & Mail To: James Watters (aka: Sendero Slim), 6800 West Gate Blvd, Suite 132, Austin, TX 78745

Questions ~ Call: 512-261-9922 or e-mail: Thomas Pollock (aka: Judge Menday Coming) tp1836@prodigy.net

Applicant Information

Date: ___________________________ Membership Application _____ Renewal Application _____ (Check one)

Name: _________________________________________ Alias: _______________________________________

Address: ________________________________________ City: _____________________ State: ___ Zip: _____ Home Phone: ___________________ Cell Phone: ___________________ Email: _________________________

Date of Birth: _____________ (Individual applicants must be at least 18 years of age)

Emergency Contact

Name: _______________________________________________ Phone Number:_________________

Name: _______________________________________________ Phone Number:_________________

Membership Level (check one)

Individual ($40) _____ Existing Life-Individual _____ *Family ($50) _____ *Existing Life-Family _____

** Cattle Baron ($500) _____ **El Patrón ($1000) _____ *Each family member completes a form

**Cattle Baron and **El Patrón: These categories offer opportunity for members to express their loyalty and support of the Tejas Caballeros in a special way. Truly, these are the men and women who make things happen for the Tejas Caballeros. Members in these categories receive a photo identification card good for 12 shoots, including one Whoopin’, which may be used at anytime in any year plus a number of other member and personal benefits. Go to: Membership Categories Page

SASS Member: _____ Yes/No _____ Number: __________________

NRA Member: _____ Yes/No _____ Number: __________________

Release of Liability Affidavit

The Pledge: I CERTIFY that I am a citizen of good repute of the United States of America; that I am not a member of any organization or group having as its purpose or one of its purpose the overthrow by force and violence of the United States or any of its political subdivisions; that I have never been convicted of a crime of violence; and that if admitted to membership, I will fulfill the obligations of good sportsmanship and good citizenship.

By signing below, I CERTIFY that I am not precluded from possessing a firearm by law, that I know how to safely handle the firearms I use, know the safety rules that pertain to firearms and their use, and I will always follow such rules while at any Tejas Caballeros function. I do hereby release and discharge the Tejas Caballeros and their officers, representatives, agents, servants, directors, employees, and/or any land owner or operating facility associated with the Tejas Caballeros, from any and all liability, of every kind and character, howsoever arising, including bodily injuries and loss or damage of property, sustained by me, my guest, and any other person or entity, having or asserting claims or rights, by, through, or under me. I covenant and agree to hold harmless and indemnify the said entities and persons from any claims of the nature released or discharged, arising by, through, or under me. I understand that this affidavit will be binding until May 31, 2011 at any and all gatherings of the Tejas Caballeros.

_______________________________________________________ _______________ ________________________________________

Legal Signature Date Printed Name

Minor Release of Liability

I, the undersigned below, do certify as parent, guardian, or custodial parent, on behalf of my minor child or ward, the above referenced release of liability, and grant expressed permission for my minor child or ward to participate in club activities.

_______________________________________________________ _______________ ________________________________________

Parent or Guardian Legal Signature Date Printed Name

For Office Use only

Date Paid: _______________ Amount Paid: _______________ Received by: ____________________ Cash: ___ or Check #:___________