CAPITAL SKI CLUB MEMBERSHIP APPLICATION

Print and Mail to: Capital Ski Club

P.O. Box 41093

Dues Schedule (circle one)

New Member

• Initial Individual dues $35.00
• Initial Individual Senior dues +65 $30.00
• Initial Family dues $60.00

Renewal

· Individual dues $25.00

· Individual Senior dues +65 $20.00

· Family dues $40.00

Privileges of General Membership

• Voting privileges during general membership meetings
• Holding elected office after active membership for one year
• Appointment to committees and committee chair after one year

Name ___________________________________________________ DOB ___/___/___ SEX M/F ___

Spouse ____________________________________________________ DOB ___/___/___

Child _____________________________________________________ DOB ___/___/___

Address __________________________________________________________________ Apt # _______

City/State/Zip __________________________________________________________________________

Home Phone ______________ Work Phone _______________ E-Mail ____________________________

Occupation _____________________________________________New Member _____ Renewal ______

Emergency Contact _______________________________________ Phone # _______________________

Activities of Interest and/or Hobbies ________________________________________________________

______________________________________________________________________________

_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Release and Assumption of Risk

I acknowledge that snow sports are extremely dangerous and the possibility of injuries or damages can result from my participation. Therefore, I hereby agree to provide my own insurance coverage for any sickness, injuries or damages of any nature that may arise out of my participation with Capital Ski Club. I further agree to release and hold harmless Capital Ski Club, its successors, assigns, officers, agents, and any other person officially connected with Capital Ski Club from any and all claims, demands and liabilities for any injuries or damages whatsoever that may arise from my participation with Capital Ski Club.

Print Name ____________________________________________

Signature ______________________________________________ Date __________________

REV:2 5/05

Or click HERE to download Membership Application