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Northwest Vermont Endurance

Annual Membership Application

 

NWVE Annual Membership



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
PO Box103

Craftsbury Common VT, 05827


Amount Enclosed: ______