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Chesapeake Hiking & Outdoor Society

City___________________________ State ______ Zip_____
Phone_____________________________________ Email______________________________

Interests and other clubs you belong to: ________________________________________________________________________________________________________________________________________________________________________________

CHAOS maintains a website at Occasionally we like to put CHAOS trip photos on the site. Checking this box and signing this form gives us permission to use photos on the site that may contain your image. No names will ever be used in connection with these photos. o

Membership Classification (Please Circle One)

Individual ………………... $20 Household.……………….. $35

Make checks payable to John Castell and mail to:

CHAOS c/o John Castell

1252 Seminole Dr.

Arnold, MD 21012

Signing this document constitutes agreement of those signed below with the policies of the Chesapeake Hiking & Outdoor Society (CHAOS), including the following LIABILITY WAIVER STATEMENT, which MUST be signed by all persons age 18 and older who wish to belong to CHAOS.

"I am (We are) aware of the risks inherent in outdoor activities. Therefore I (we) will be responsible for my (our) own well being while participating in the activities of Chesapeake Hiking & Outdoor Society, and while traveling to and from these activities. I (We) agree that the CHAOS, its officers, representatives and trip leaders shall not be liable for any injury, loss, or damage to my (our) person(s) or property, direct or consequential, arising out of the activities of the Club. If I am a parent or guardian (if we are parents or guardians) in a household membership, I (we) agree to assume this same responsibility for my (our) minor children."

I (we) have read and understand the statement above


Print Name________________________________________________________________________


Print Name________________________________________________________________________