| Texas Twisters Ski and Adventure Club | ||||||||
| Send completed form and check to: | ||||||||
| 4414 82nd Street | DATE: | |||||||
| Suite 212, #135 | ||||||||
| Lubbock, Texas 79424 | ||||||||
| http://www.TexasTwistersSkiClub.com | ||||||||
| Bill To: | FOR: | September 2008 - August 2009 | ||||||
| (fill below with your name/address/phone number/email) | ||||||||
| Make all checks payable to Texas Twisters Ski Club | ||||||||
| DESCRIPTION | Qty | RATE | AMOUNT | |||||
| Single Membership | 30.00 | $ - | ||||||
| Family Membership | 45.00 | |||||||
| TOTAL | $ - | |||||||
| MEMBERSHIP INFORMATION | ||||||||
| Spouse's Name / email | Preferred Phone Number | |||||||
| Children/Age | Secondary Phone Number | |||||||
| Children/Age (con't) | Email address | |||||||
| On behalf of all above members, I promise that I/we know or will learn about the risks of participation in any club activity. By participating in an activity, I am/we are agreeing to assume all such risks, to defend and indemnify the club from any claim, which might arise out of my/our participation in any activity. | ||||||||
| Applicant's Signature / Date | ||||||||
| Spouse Signature / Date | ||||||||