Chugiak
Dog Mushers Association
PO Box 671523, Chugiak, AK 99567
Senior Membership Form
Effective Sept. 1 through Aug. 31
Name: ___________________ Address: ______________________________
Phone: ______________ ______________________________ ______________
e-mail: ______________________________
Race date and job you would be willing to help: _________________________________
(any date from race schedule and your job preference, if any)
Information about you or your kennel:____________________________________________
___________________________________________________________________________
| Adult Single Membership |
$ 20.00 |
| Adult Family Membership (2 Adult members) |
$ 25.00 |
| Lifetime Membership (per person) |
$250.00 |
| Annual Sponsorship |
$ |
| Total Amount Paid: |
|
Received By: ____________
Liability Release ______________________________ understand that
dog mushing can be dangerous
and can cause injury. I (we) also understand that no one can foresee
the many causes of dog mushing injuries or the many possible types
of injuries. On behalf of myself (ourselves), individually and
on behalf of my (our) children, if any, I (we) release from any
and all liability (and agree not to sue or bring claims against)
the Chugiak Dog Mushers Association and the Municipality of Anchorage
should I (we), any guest of mine (ours), or any member of my (our)
family, including my (our children, be injured at the Beach Lake
Trail System or during any event sponsored by the Chugiak Dog
Mushers Association. This release includes claims relating to
all injury of any sort, including fatal injury and including injury
which is not foreseeable at this time.
THIS IS A LEGAL DOCUMENT
Read Before Signing
____________________________
Signature |
____________________________
Signature |
_________________________
Date |
_________________________
Date |
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