|
*
Click For
Printer Friendly Versions (pdf Format)
Philadelphia Triathlon Club
JOIN/RENEW MEMBERSHIP FORM
Name:
____________________________________________________________________________________
Address:
__________________________________________________________________________________
City: ______________________________________________ State:
____________ Zip: _______________
Email:
_____________________________________________ Home Phone:
_________________________
Work Phone:
_______________________________________ Mobile:
_______________________________
Occupation:____________________ DOB: _______________________
(Junior Member if not 18
years of age)
Membership: New
Member *
Renewing Member
*
USAT No.
_____________________________
Races Planned for
2008: ________________________________________________________________
Volunteer Interests:
Races *
Events *
Group Workouts
*
Tailgates *
Other
________________
Waiver of Liability.
Please read carefully and sign below:
In consideration of my membership in, and
any benefits afforded by, Philadelphia Triathlon Club (PTC), I for myself,
executors, heirs, next of kin, administrators, and for anyone else who might
claim or sue on my behalf, assume any and all risks and associated with my
traveling to or from and participation in a PTC activity, event or workout.
I hereby waive, release and discharge any and all claims, losses or
liabilities for death, personal injury, partial or permanent disability,
property damage, medical or hospital bills, theft or damage of any kind,
including without limitation any economic losses, which may arise out of or
relate to my participation in or traveling to or from a PTC activity, event
or workout that may arise now or in the future against PTC, and its
organizers, directors, members, officers, sponsors, volunteers and any other
individuals or entities associated with PTC. I also grant permission to PTC
and its organizers, directors, members, officers, sponsors, volunteers and
any other individual or person associated with PTC to photograph, videotape
and record me while participating in a PTC activity, event or workout for
the use and publication in promotional materials, advertisement and
reports. I further authorize the use and release of my name and age and
other directory information. I also grant my permission for a doctor and/or
nurse to take remedial action in case of an emergency, and that I assume all
expenses in the event of an accident, illness or other incapacity,
regardless of whether I have authorized such expenses.
By signing below I: (i) agree to and accept
the terms and conditions of this Waiver of Liability; (ii) will respect and
adhere to all club requirements, benefits, sponsorships, pro deals, etc.;
and (iii) remain a loyal PTC member throughout this enlisted year.
Signature: ____________________________________ Date:
__________________
___________________________________ (Parent
or legal guardian must sign for junior member)
Dues $40.00. Submit form and check payable to:
Philadelphia Triathlon Club
Attn: Membership
PO
Box 29126
Philadelphia, PA 19127 |
|
