Name(s):____________________________________________________________
____________________________________________________________________
Phone
No.:________________________________________________________________
Address:____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
e-mail
address__________________________________________________________
Membership
Single ($10)________Family ($15)_____ New _______ Renewal______
The
UNDERSIGNED, for and in consideration of the privilege of participating in
events and activities organized and sponsored by VELO GIRARDEAU, hereby
covenants and agrees not to sue VELO GIRARDEAU, its officers or agents for
damages which may be incurred by the UNDERSIGNED arising out of the
UNDERSIGNED'S participation in such activities or events and caused by the
negligence of VELO GIRARDEAU its officers or agents.
Dated
the____________day of________________________ ,2007
Sign
here:_____________________________________________(Member's signature required)
_____________________________________________
Parent
or guardian must sign for member under the age 18.
____________________________________________________________________
mail
to:
Velo Girardeau
P.O. Box 953
Cape Girardeau, Missouri
63702-0953
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