Cowboy Action Shooting Club
MembershipApplication and Renewal – Please Complete with All Information
Print/Complete & Deliver or Mail To: Treasurer, Tejas Caballeros, 225 Hogg Pecan Pass, Austin, TX 78748
Questions ~ Call: 512-964-9955 or e-mail: Thomas Pollock (aka: Judge Menday Coming)
Please Type or Print Legibly
Applicant Information
Date: ______Membership Application _____/ or Renewal Application _____ (Check one)
Name: ______Alias: ______
Address: ______City: ______State: ___ Zip: _____ Home Phone: ______Cell Phone: ______Email: ______
Date of Birth: ______(Applicants must be at least 21 years of age or sponsored by parent or guardian)
Medical Emergency and Contact Information
Allergies or Conditions: ______
Emergency Contact: ______Phone Number:______
Membership Level (check one): Individual ($25) _____ Family*($40) _____ Existing Life-Individual _____ Existing Life-Family* _____
**Town Managers ($250) _____ **Town Sheriff ($500) _____**Town Mayor($1000) _____
*Each adult member must complete a Renewal & Liability Release form
**Town Managers, Town Sheriff and Town Mayor: Truly, these are the men and women who make things happen for the Tejas Caballeros. Members in these categories pay no shoot fees for the year, receive a fancy name badge and reserved parking for year.
SASS Member: _____ Yes/No _____ Number: ______NRA Member:_____ Yes/No _____Number: ______
TSRA Member: _____ Yes/No _____Number: ______
Release of Liability Affidavit
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 accept and assume the risks associated with firearms use by me and others. 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 meEven though caused in whole or in part by the negligence (whether sole, joint or concurrent), gross negligence, strict liability or other legal fault of the Tejas Caballeros and their officers, representatives, agents, servants, directors, employees, and/or any land owner or operating facility associated with the Tejas Caballeros (or any such indemnities).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 grant Tejas Caballeros the right to use photographs and video recordings of me participating in Tejas Caballeros events or at the Texas Republic Ranch for any lawful purpose, including without limitation, printed, electronic, and video content. This affidavit is binding until January 31, 2019 at any and all gatherings of the Tejas Caballeros.
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Legal SignatureDatePrinted 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.
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Parent or Guardian Legal SignatureDatePrinted Name
For Office Use only
Date Paid: ______Amount Paid: _____ Received by: ______Cash: __ or Check #:______Revised 1/13/2017