MEMBERSHIP FORM
ANNUAL DUES ARE $10 PER PERSON
For fiscal year July 1 to June 30 and will not be prorated for a partial year.
Last Name _____________________________________ First Name _______________________________
Mailing address___________________________________________________________________________
City/State___________________________________________________________Zip___________________
Email address ____________________________________________________________________________
(The majority of VCPC correspondence is e-mailed from the club officers)
Preferred Phone_________________________________ cell, home or office (circle one)
Dues Paid $ ________________
Please make checks payable to VCPC and mail to the Treasurer:
Lou Blas
PO Box 1010
McCall, Idaho 83638
Release of Liability, Assumption of Risk -- Please Sign & Date
____ VCPC does not do any evaluation or recommendation as to whether I am fit for exercise and recommends that I obtain medical clearance from my physician before use.
____ I agree there is risk of injury or death associated with my use of pickleball facilities. VCPC does not provide a person to monitor use of these facilities or provide instruction regarding any aspect of the facilities. I am voluntarily participating in the activities of the VCPC.
____ I release, waive and forever discharge VCPC and its officers, directors, and members from any and all claims, demands, damages, actions, and lawsuits resulting from my injury or death due to the negligence of or any other conduct of the VCPC or its members.
____ I agree to indemnify and defend the VCPC and its agents from any claims made by any individual having used or claiming to have used their facilities through or under me or my membership.
I agree to all of the above statements: _____________________________ Date____________________
PLEASE FILL OUT, SIGN, AND MAIL A FORM (ALONG WITH $10 DUES) FOR EACH MEMBER JOINING THE VCPC.