MEMBERSHIP APPLICATION 2002

NAME: .................................................................................. DOB: ........................................

ADDRESS: ..............................................................................................................................

PHONE: ................................................ AGE:...........................SEX:.......................................

Cadets: U 16 at 1st January 2002
Masters: 35 at 1st January 2002
Juniors: U18 at 1st January 2002
Opens: Mens and Womens Seniors: 28 years at 1st January 2002

T - SHIRT SIZE: (Please Circle) XS S M L XL XXL

I hereby indemnify the Bay Area Boardriders Inc and its leaders against any claim which may be made on behalf of the abovenamed member arising from accident or injury occuring in any contest or function event. I also give the Bay Area Boardriders Inc permission to seek any medical assistance necessary for the abovenamed member in the unforeseen event of an accident or injury if I can not be contacted. I also indemnify the Bay Area Boardriders Inc against claims which may arise from the loss of property or damage to property during any club contest or event.

SIGNED: ................................................................................DATE: .......................................
(Parent or Guardian if under 18 years of age)

MEMBERSHIP FEES: (Free T-Shirt when membership is paid)

FEES PAYABLE NO LATER THAN 1ST MARCH 2003.

Mail or fax to : 108 Government Road, Nelson Bay NSW 2315 or 4984 4499
(Attention Teresa Richardson)

Thankyou .......Teresa Richardson

© Bay Area Board Riders Inc. 2002 All Rights Reserved