Burleson Mounties Riding Club           

Member of District 10 of the National Association of Riding Clubs and Sheriffs Posses

Club Dues  $20.00/year per family     Association Dues  $35.00/year per family (optional)

Last Name: ________________________________

First Name: ________________________________             Date of Birth: _________________

Spouse’s Name: ____________________________              Date of Birth: _________________

Children:

Name: _______________________________           Date of Birth:_________________

Name: _______________________________           Date of Birth: _________________

Name: _______________________________           Date of Birth: _________________

Name: _______________________________           Date of Birth: _________________

Address: _________________________________________________

City:  __________________________  State: ______________   Zip Code: __________-______

Send dues to:

                        Vickey Sanders

                        8521 County Road 1004

                        Godley, TX 76044

                        817-309-2095

Date: ________________________________