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 donation payable to NWVE. NWVE C/O Damian Bolduc
93 Butler Drive South Burlington VT, 05403 Amount Enclosed: ______ |