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CHAOS Membership Form

Chesapeake Hiking & Outdoor Society

Name(s)______________________________________________________________________
Address______________________________________________________________________
City___________________________ State ______ Zip_____
Phone_____________________________________ Email______________________________

Interests and other clubs you belong to: ____________________________________________________________________________________________________________________________________________________________

CHAOS maintains a website at http://jenzakayaker.tripod.com/CHAOS/ . 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. c

Membership Classification (Please Circle One)

Individual ... $15 Household... $20

 

Make checks payable to Jenny Ford and mail to:

CHAOS
PO Box 6039
Annapolis MD 21401

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.

LIABILITY WAIVER STATEMENT
"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

Signed___________________________________________________Date_____________________

Print Name________________________________________________________________________

Signed___________________________________________________Date_____________________

Print Name________________________________________________________________________