Bell Show Society Inc ABN 85 235 868 022 TAX INVOICE BELL CAMPDRAFT 3rd, 4th & 5th July, 2015 Nomination Form Competitor: ................................................................................................ ACA Membership Number: ................... Address: ............................................................................................ Telephone: .................................................... Email: ................................................................................................ Mobile:…………………………………………. Note: ONE COMPETITOR PER FORM, PLEASE COPY. All fees are GST inclusive. All riders are restricted to 8 (eight) first round starts. MAIDEN $25 HORSE NAME NOVICE $35 OPEN $50 Horses will be placed in draw according to nominated order. ENCOURAGEMENT $22 NOMINATIONS MUST BE PAID IN FULL BY WEDNESDAY 24TH JUNE, 2015 JUVENILE $14 JUNIOR $12 TOTAL ASH No. Cheque/Money Order Attached TO BE ELIGIBLE FOR THE HIGHEST SCORING REGISTERED ASH PRIZE, ASH NO MUST BE COMPLETED. Are you registered for GST? Yes/No If yes, what is your ABN?__________________________________ Please make Cheques or Money Orders payable to “Bell Show Society” Post to: Karen Dorman, P O Box 71, BELL QLD 4408.Ph: 0438 977 961 NO NOMINATIONS ACCEPTED WITHOUT NOMINATION FORM, SIGNED WAIVER, PAYMENT & HORSE HEALTH DECLARATION. # For updates us on – Bell Campdraft. Draws will be available on www.bellshow.com.au Wednesday 1st July, 2015. RELEASE AND WAIVER OF LIABILITY EXCLUSION OF CERTAIN RIGHTS TO SUE The purpose of this agreement is to limit the liability of the Provider to exclude liability for any personal injury or death to the Participant, and other people in the care and control of the Participant, howsoever caused, who signed this form as acknowledgment of the terms and conditions of this agreement. By signing this form you are waiving your rights to sue the Provider for losses relating to personal injury or death. Under the provisions of the Trade Practices Act and various State Laws conditions are implied into contracts that mean that the Provider of Recreational Services, noted below, is required to ensure that the Recreational Services it sells to you are: rendered with due care and skill, are fit for the purpose for which they are commonly bought as it is reasonable to expect in the circumstances. Name and address of Provider: BELL SHOW SOCIETY INC, & CAMPDRAFT COMMITTEE, WALLACE ST, BELL 4408 I understand and acknowledge that horse events can be a dangerous activity. I understand and acknowledge that serious INJURY or DEATH may result from competing/participating in Team Penning, Cutting, Cattle Work and any other horse riding activities. I agree that I RIDE at my OWN RISK at all BELL SHOW SOCIETY INC events and that the BELL SHOW SOCIETY AND THE CAMPDRAFT COMMITTEE shall not be liable for my personal injury, death, loss or damage occasioned to me or loss or damaged occasioned to any of my possessions. If 18 years old or under a helmet must be worn at all times whilst riding on the grounds. CONDUCT I understand and acknowledge not to compete/participate whilst under the influence of alcohol or drugs prohibited by law. I understand not to ride in a dangerous manner, which may cause injury to others or myself. I understand and acknowledge the rules and the safety requirements of the activities in which I wish to participate Name of Competitor/s/Participant/s (Please print clearly) Name of Parent or Guardian: Applicable if competitor/participant is under 18 years of age Competitor Address: Contact No: Town Postcode: Email: : EFFECT OF THIS DOCUMENT I understand that my signature to this document constitutes a complete and unconditional release of liability of the BELL SHOW SOCIETY INC AND CAMPDRAFT COMMITTEE to the greatest extent allowed by law in the event of me and/or the children under my care against suffering injury or death. Signed:___________________________________________________________ Dated:_________________________