| Grand River, Iowa 50108 641-773-5232 |
Print Clearly
| Date:________________ | After April 1st add $10.00 |
| Contestant/Personnel: $75.00 |
Timers (Only): $45.00 | Newsletter: $25.00 |
| Circle One: New Old | |
| Name:_____________________________________ | IRA #:_________________ |
| Address:___________________________________ | City:___________________ |
| State:________________ | Zip:_____________ | Phone:____________________ |
| Date of Birth:________________________ | Soc. Sec. #:__________________________ |
| Bareback | Saddle Bronc | Bull Riding | Calf Roping |
| Forty & Over CR | Break-away | Barrel Racing | Team Roping |
| Steer Wrestling | Timer | Judge | Pick-up Man |
| Bull Fighter | Photographer | Barrel Man | Specialty Act |
| Stock Contractor | Producer | Announcer | Clown |
| Secretary | Other____________________ |
Applicants under 21
I certify that the age and date of birth of the below named child is correct, and I hereby consent to the participation of my/our child in the Interstates Rodeo Association, Inc. I agree that in no event will I hold the IRA, Inc., its agents, or employees liable for injury or property damage during participation at an IRA
sanctioned rodeo or while enroute to or from an IRA sanctioned rodeo.
| Applicant:_______________________________________________ | Birth Date:_______________________________ |
| Address:_______________________________________ | Age:_______________________________ |
| City & State:____________________________________________ | Zip:_______________________________ |
| Phone:__________________________________ | Soc. Sec. #:____________________________________ |
The foregoing instrument was acknowledged before me this __________________day of _________ 20______ by
_____________________________________ parent or guardian of the above IRA contestant, and I certify that the above information is
true to the best of my knowledge.
Notary Public ____________________________________Date ____________________ My Commission Expires ___________________________