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membership Brighton Dragon Boat Club Membership Agreement 2010 NAME please print

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membership Brighton Dragon Boat Club Membership Agreement 2010 NAME please print Powered By Docstoc
					                                Brighton Dragon Boat Club
                                Membership Agreement 2010
NAME: (please print)________________________

PHONE: (home)__-__ __ __-__ __ __ -__ __ __ __(cell)__-__ __ __-__ __ __-__ __ __ __

ADDRESS:___________________________________________________________________________
Postal Code____________________________

E-MAIL ADDRESS (please print)__________________________________

BIRTH DATE: (month/day/year)____________________

CONTACT NAME: (in case of emergency)________________________

CONTACT’S PHONE #: (in case of emergency) __-__ __ __-__ __ __-__ __ __ __
FEE SCALE:
        Regular Member (years 20-64) $125.00
        Student (years 12-19) $ 25.00
        Cancer Survivor $ 50.00
     Senior (years 65 plus) $ 90.00
PAYMENT METHOD: (Cheques payable to the Brighton Dragon Boat Club)
        Cash ……….Amount: (check one)___$125 ___$25 ___$50___ $90___
        Cheque……..Amount: (check one)___$125 ___$25 ___$50___ $90___

AGREEMENT: In consideration of accepting my membership or the membership of my child or ward, I
for myself, my heirs, my child or ward, my executors and administrators of those of my child or ward, do
hereby release and forever discharge the Brighton Dragon Boat Club or any associated sponsors or
persons associated with the Brighton Dragon Boat Club against any loss or damage, occurring prior to,
during, or subsequent to my participation, to my person or property, however caused. I hereby agree to
read and sign the official Waiver of Liability and Release before becoming an official member of the
Brighton Dragon Boat Club.
APPLICANT’S SIGNATURE:_________________DATE: (month/day/year)_______________

WITNESS SIGNATURE:_____________________DATE:(month/day/year)_______________

SIGNATURE OF PARENT OR GUARDIAN (for paddlers under 18)______________________

NAME: (print clearly)___________________SIGNATURE:_____________DATE:__________

MAIL MEMBERSHIPS (cheques in mail only)
Sharon Caswell
Communications/Recruitment
Brighton Dragon Boat Club Box 633
Brighton ON
K0K 1H0
INFORMATION: (website) www.brightondragonboat.com...or...sharoncaswell@kos.net

				
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posted:12/3/2011
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