| * required fields |
|
*Name
|
|
| *Address |
|
| *City |
|
| *State |
|
| *Zip Code |
|
Telephone
(include at least one) |
Home:
Cell:
Work:
|
| *Birthday |
Birthday
|
| *Marital Status |
Single Separated
|
| *Email Address |
|
| *What activities do you enjoy? |
|
| Referred by |
Plese give the full name of the TB member or the title of the newspaper. (Optional) |
| Because of some of the activities we do — white water rafting, scuba diving, horseback riding, cycling, canoeing, hiking etc. — and the
element of risks associated with them, we ask members to furnish the name and telephone number of a person to contact in case of an
emergency. This information is confidential, and would only be used in the event of an emergency. Please list the name(s) below:
|
| *Emergency Contact |
Name:
Phone: |
The undersigned acknowledges any risks undertaken when involved in any TRAILBLAZERS, Inc. event or activity, and shall not hold
“TRAILBLAZERS, AN ADVENTUROUS OUTING CLUB FOR SINGLES, INC.”, its officers or event sponsors, responsible for any
physical or financial damages he/she may suffer while participating in club activities. I understand that the Trailblazers Singles Club does not
screen club members nor guests and that neither the Board of Directors, nor the Club is to be held responsible for any actions of any person(s)
involved with club activities.
I agree to these terms.
|
