WaiverForever

Membership Registration Form Membership Type Please check one Date my membership began Referred by Personal Information Name Title Position Company/Institution Full Mailing Address Email Address Phone Occasionally we would like to contact you with details of services, educational updates, and organizational updates. If you consent to us contacting you for this purpose, please check the box below corresponding to acceptable contact methods The contact information you provide us will be used for all mailings and may be published in the club website membership database. We do not sell or share our membership list to third parties. If you have concerns or questions, please contact XXX at [email protected] The collection, use, and processing of the personal information I provide to Club in this Membership Application for the purposes of organization administration, payment of my dues, and inclusion of my contact information in a members’ directory that will be distributed to members and employees of Club. In addition, the collection, use, and processing of my personal information collected by Club and by electronic communications. By my signature below, I agree to the terms of Club and the Member’s Agreement and Release stated above, and certify that I am 18 years of age or older (in compliance with the Club Policy ). I acknowledge that my electronic signature on this document is legally equivalent to my handwritten signature