Upper Bucks Ski Club

Member of the Eastern Pennsylvania Ski Council

Membership Application, Renewal Form & Release Waiver

October 1, 2007 – September 30, 2008
Name__________________________________________ Home Phone ______________________________________
Last First Cell Phone _________________________________________
Work Phone ________________________________________
Spouse_________________________________________ E-mail: _________________________________
             Last     First
Address_______________________________________________________________________________
            Street            City            State             Zip Code
Dependent____________________________Date of Birth____/____/_____Dependent_____________________________Date of Birth____/____/_____
Dependent____________________________Date of Birth____/____/_____Dependent_____________________________Date of Birth____/____/_____
 New Member  Renewal  Change of Address  Single - $15 - Person 18 years or older
 Ski  Snowboard  Both - Ski & Snowboard  Family - $25 - Partners of same household and their dependent children
What type of group trip would you prefer?
 Day Trips  Weekend Trips  Midweek  PA NY Vermont Maine Colorado
 Extended Weekend  Week Trips  Bus  New Hampshire   Quebec, Canada Other ___________________________________
 Drive-Up
Release and Waiver All adults must sign the Release of Liability below We, for ourselves and for our dependents named herein as part of this membership application, acknowledge that the activities of the club will expose me/us to inherent and other risks and accept these risks that can cause, or contribute to serious injury or death. We/ I, intending to be legally bound, do hereby release from liability and hold harmless the Upper Bucks Ski Club, its officers, board members and volunteer supporters for any damage, injury, or death to myself or to any person or property, caused by any reason, in any way connected with participation in any and all club events. We do not, however, release or waive any claim or action which may arise out of willful or wanton negligence. This release contains the entire agreement between the parties hereto and that the terms are contractual and not a mere recital.

Signature_____________________________Date_________Signature____________________________Date________

Please make checks payable to Upper Bucks Ski Club
Send to : Upper Bucks Ski Club Membership
 P.O. Box 25 Quakertown, PA 18951-0025

Please include self-addressed, stamped envelope unless picking your card up at the next meeting

 

UBSC informational section Cash Check #___________ Amount Paid: $______________ Membership Card Issued, Member No_________