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BOEING
EMPLOYEES SCUBA CLUB (SEA HORSES) MEMBERSHIP FORM |
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Circle all that
apply: New
member Renewal Individual Family Change information |
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Member
Information ( fill in the appropriate boxes) |
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(last name) |
(first name) |
M.I. |
BEMSID |
Mail-Stop |
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(street address) |
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(city) |
(state) |
(zip code) |
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(area code) (work phone) |
(e-mail) (work) |
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(area code) (home phone) |
(e-mail) (home) |
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Dues
(New members
joining after June 30th pay ˝ dues) |
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Initiation (one time fee for new
members) |
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$10 |
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Regular Membership (individual
employee, contractor, or supplier) |
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$20 |
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Family Membership (includes spouse
and dependent children of member) |
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$30 |
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Associate Membership (former
employee, qualifying family member) |
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$30 |
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Retiree membership (retired per
Boeing rules) |
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x |
$5 |
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Late fee (renewing after May 1st) |
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x |
$5 |
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Total (make check payable
to: Boeing Employees Scuba Diving Club) |
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(number of dives) |
(Certification level) |
PSI # ______________ Compressor members ( VCI/PSI ) |
WSBE # ____________________ (Washington State Boating
Education card number) |
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(member
signature) |
(date) |
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Sponsored Family Member Information: |
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Last Name |
First
Name |
E-Mail |
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Please
complete this form, sign, and send your check to:
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George Barron, M/S 03-KR The Boeing Co. |
NOTES: Each
participant in club activities MUST fill-out and sign the Release of
Liability and Indemnification Agreement.
A parent or legal guardian must sign for each minor under age 18. Each
Associate member must also fill-out the separate Associate Membership
form. See the Associate Membership
form for qualification rules. |
RELEASE AND INDEMNITY AGREEMENT
In consideration for
the right to participate in the Club’s activities, i hereby release the club and
their directors, officers, instructors and members and the boeing company, its
directors, officers, and employees from any and all liability, claims and
causes of action arising out of or in any way connected with my participation
in any of the club’s activities. i
personally assume all risks in connection with these activities, and further
agree to indemnify the club and its directors, officers, members and
instructors, and the boeing company, its directors, officers, and employees
from all liability, claims and causes of action which i may have arising from
my participation in club activities.
The terms of this agreement will serve as a release and indemnity
agreement for my heirs, personal representative, and for all members of my
family, including any minors.
I further state that I am eighteen (18) years of age or older and legally competent to sign this release that I understand these terms are contractual and not a mere recital, and that I have signed this document as my own free act. (Parents or legal guardians must sign for all persons under eighteen (18) years of age).
I have fully informed
myself of the contents if this release and indemnity by reading it before I
signed it.
For the calendar year
2010__ Participant’s Name: __________________________________
(Please Print)
_________________________________________________ ________________
(Participant’s
Signature) (Date signed)
_________________________________________________ _______________
(Parent / Legal
Guardian’s Signature) (Date signed)