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NWVE

Northwest Vermont Endurance

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NWVE Membership Application

 

Last Name ____________________First Name __________________

Address __________________________________________________

City _____________________________State _____Zip ____________

Telephone (______) ____________________  Email ________________
                                                                      
Sex ____ Birthdate ___/___/___Age _____

If family membership:
Name ___________________________ Sex ___ Birthdate __/__/__ Email _____________________________
Name ___________________________ Sex ___ Birthdate __/__/__ Email _____________________________
Name ___________________________ Sex ___ Birthdate __/__/__ Email _____________________________
Name ___________________________ Sex ___ Birthdate __/__/__ Email _____________________________
Name ___________________________ Sex ___ Birthdate __/__/__ Email _____________________________

Member signature: __________________________  Date: ______
(Skier or Parent's signature if under 18 years old)

Note: By signing the above, I agree to follow all NWVE and NENSA rules in club skiing events and for myself, heirs, executors, and administrators waive and release any rights and claims for damages I may have against the sponsors, directors, staff, NWVE, NENSA, and USSA  for any injuries suffered by me in NWVE  activities.

Send this form with optional (suggested minimum $30.00) donation payable to NWVE. 

NWVE

C/O Damian Bolduc
93 Butler Drive

South Burlington VT, 05403

Amount Enclosed: ______