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New Member Registration Form
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Name
*
First
Last
Nick Name
Email
*
Street
City
State
Zip
Phone 1
Type
Cell
Home
Work
Phone 2
Type
Cell
Home
Work
Phone 3
Type
Cell
Home
Work
In Case of Emergency (ICE) Name
ICE Phone
Type
Cell
Home
Work
Marital
Single
Married
Birth Month
1
1
2
3
4
5
6
7
8
9
10
11
12
Birthday Day
1
2
3
4
5
Choice 29
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
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31
I would like to participate in the following activities
Ski
Racing
Membership
Tennis
Volleyball
Social
Ways & Means
Public Affairs
Computer
Golf
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Message
In consideration of the BSSC’s acceptance of my membership and renewal thereof, and for other good and valuable consideration, I, on my behalf and the behalf of my legal representatives, including my spouse, if any, and insurers, do hereby waive, release and forever discharge the BSSC, its officers, directors, employees and agents including but not limited to activity leaders, of and from any and all claims, loss, cost, damage to property which I may sustain as a consequence of the negligence of any such entity or person in connection with or related to any activity arranged, organized, sponsored or managed by BSSC, including transportation to and from such activity. I understand that BSSC will not accept my membership unless I sign or check ‘Accept’ of this Release, which I have read and to which I voluntarily agree.
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