INTERNATIONAL FEEDLOT COWBOY ASSOCIATION
REGION 11
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NAME SOCIAL SECURITY NUMBER E-MAIL ADDRESS
_____________________________ _____________________________ _____________________________
ADDRESS CITY/STATE/ZIP PHONE CELL PHONE
PARTICIPATING SPOUSE AND/OR CHIDREN INFORMATION
NAME ____________________________ SSN _____________________________ USTRC # _________ HD ________ HL
NAME ____________________________ SSN _____________________________ USTRC # _________ HD ________ HL
NAME ____________________________ SSN _____________________________ USTRC # _________ HD ________ HL
NAME ____________________________ SSN _____________________________ USTRC # _________ HD ________ HL
1. ELIGIBILITY WILL BE CONFIRMED BY REGIONAL DIRECTORS.
2. ALL PROTESTS MADE BY AN ACTIVE IFCA MEMBER WILL BE INVESTIGATED BY A GRIEVANCE COMMITTEE. ANY AND ALL MONEY WILL BE
HELD UNTIL A DECISION IS MADE BY THE GRIEVANCE COMMITTEE, WHOSE DECISION WILL BE FINAL.
3. THERE WILL BE A TWO WEEK GRACE PERIOD FOR CHANINGING EMPLOYMENT FROM ONE FEEDYARD TO ANOTHER.
I UNDERSTAND FALSIFYING ELIGIBILTY INFORMATION WILL RESULT IN THE LOSS OF ANY FEES PAID BY MYSELF AND/OR MY PARTNERS AND BOTH MAY BE CONSIDERED INELIGIBLE UNCONDITIONALLY FOR PARTICIPATION IN IFCA EVENTS FOR A PERIOD OF THREE (3) YEARS.
______________________________________ ______________________ USTRC # _________HD _________HL
SIGNATURE DATE
NOTARY SIGNATURE ___________________________________________________ MY COMMISSION EXPIRES __________________________
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_______________________________________________ IS EMPLOYED A MINIMUM OF 40 HOURS PER WEEK BY
NAME
________________________________________________ _______________________________________________________
FEEDYARD/COMPANY ADDRESS
____________________________________________________ __________________________________ __________________________
CITY/STATE/ZIP PHONE HIRE DATE
_______________________________________________________________________________________ __________________
SIGNATURE FEEDYARD/COMPANY OWNER/MANAGER/ IMMEDIATE SUPERVISOR/IFCA REGIONAL DIRECTOR DATE
NOTARY SIGNATURE ____________________________________________________ MY COMMISSION EXPIRES _________________________
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ADDITIONAL INFORMATION MAY BE REQUIRE BY DIRECTORS
LIFECARD DUES: (GO DIRECTLY TO IFCA SCHOLARSHIP FUND) $__________CASH $__________CHECK
NATIONAL DUES: $20 PER PERSON$ __________CASH $__________CHECK
NATIONAL DUES MUST BE PAID BEFORE ROPING IN REGIONAL ROPING
AUDRA LUJAN LLOYD LUJAN
503 A 9TH AVE 4060 US HWY 60
CANYON, TX 79015 HEREFORD, TEXAS 79045
806-344-6813 806-344-7813
THIS FORM MUST BE COMPLETELY FILLED OUT AND TURNED IN BEFORE REGIONAL ROPING.
THIS FORM WILL BE KEPT ON FILE WITH REGIONAL DIRECTOR AND TAKEN TO THE FINALS.
IFCA DRESS CODE ENFORCED
SEWN IN COLLAR, FULL BUTTON FRONT, LONG OR SHORT SLEEVE SHIRT.
BOOTS OR APPROVED SHOE WITH HEEL. HAT OR NO HAT OR IFCA CAPS!