Hiking Release Waiver

Document Sample
Hiking Release Waiver Powered By Docstoc
					                                                                    Mt. Laurel Skiers, Inc.
                                                              2010 - 2011 Membership Renewal
                      3 Easy steps to complete your application:
                          1. Fill out your Name, e-Mail Address, and only items that have changed since last renewal.
                          2. Save the form and send it as an attached file to membership@mtlski.com.
                          3. Print the form, sign it, and send it with your dues (cash or check) to the address shown below.

                                  Renewal Type                                                                              Club Dues:
     Number of Members in Household                                                                                          Late Fee*: $                   15.00
                                                                                                                            Total Dues: $                   15.00
                       * If payment not postmarked by September 1, 2010, a late fee of $15.00 must be included

                       Household: (Any 2 adults at same address, children under 18, children 18-22 attending post-secondary)
                       Individual: (18 years and older)
                       Student: (18 - 24 attending post-secondary education)

                     Last Name (Adult 1)                                                                              Are you an instructor?
                     First Name (Adult 1)                                                                             Downhill
                     Last Name (Adult 2)                                                                              Cross Country
                     First Name (Adult 2)
                           Street Address                                                                             Tell us about your interests:
                                      City                                                                            Downhill Skiing
                                     State                                                                            Downhill Racing
                                 Zip Code                                                                             Cross Country
      Home Phone (include Area Code)                                                                                  Hiking
       Office / Cell (include Area Code)                                                                              Biking
                                  E-mail 1                                                                            Kayaking
                                  E-mail 2                                                                            Golf
  Opt out of MTL Vendor e-mail notices                                                                                Club Travel

                          Additional household members enrolling with this application (list all children)
                      Name                                                Relationship                                      Gender              Date of Birth

                                                          Membership Application & Waiver

  I hereby waive, release and discharge from any and all claims or liabilities against Mt. Laurel Skiers, Inc., its officers, Board of Members, activity leaders, or
  trip organizers for any injury I might sustain on Mt. Laurel Skiers, Inc. sponsored programs or trips. I attest that I am physically fit and have been advised and
  prepared for the possible hazards of these events. I hereby affirm that I am 18 years of age or older and that I have read this document and understand its

  * Signature(s)____________________________________________________________________________________
                    * All adult members included in this application must sign the printed copy that you submit with your check

Make checks payable to: Mt. Laurel Skiers, Inc.
                                                                                                                       Club Use Only:
MAIL TO: Chuck Hannah
                                                                                                                         Amt Pd Cash
        MTL Skiers
        344 Monaco Lane                                                                                                 Amt Pd Check
        Glastonbury, CT 06033                                                                                                    Ck #
                                                                                                                        Date Received
Member Type - Prospective            Prosective Dues                     Renewal
                                                       Member Type -Renewal Dues
New Prospective (Household)              $105          Charter / Life Time
New Prospective (Individual)              $80          Household             $80
New Prospective (Student)                 $25          Individual            $55
Prospective Carryover (Household)         $80                                 (Household)
                                                       Prospective Carryover$80
Prospective Carryover (Individual)        $55                                 (Individual)
                                                       Prospective Carryover$55
Prospective Carryover (Student)           $25                                 (Student)
                                                       Prospective Carryover$25
                                                       Student               $25
Gender              Opt Out
F                   Include me
M                   Opt out

Renewal Required by: /1/12010

Shared By:
Description: Hiking Release Waiver document sample