MEMBERSHIP APPLICATION OR RENEWAL AND RELEASE
The undersigned hereby applies for membership or renewal, in the LONG ISLAND FLYRODDERS, INC. ("LIFR"). I understand the inherent risk in participating in the activities of LIFR, including fishing trips, of one day or longer, which LIFR may make available to members. I understand that LIFR activities may take me into remote areas, and that I may not be able to be promptly evacuated or receive proper medical care in the event of injury or disease. I further understand that I am solely responsible for all costs of medical treatment and transportation.Intending to be legally bound, for myself, my heirs, executors, and administrators, except to the extent that indemnity insurance is available, I waive, release, indemnify, and hold harmless, LIFR, its Officers, Board of Directors, and members, against any and all claims for personal injury, disease, death, and property damage or loss, that I may incur, arising out of or connected in any way with any and all LIFR activities. I assume the risk of undertaking all LIFR activities, including related travel.
In case of emergency, when reasonably feasible, contact:
name: ___________________________________________ relationship: __________________
phone: home ( ) _________________________ office (
) _________________________
| date: ___ / ___ 20 ___ | MEMBER signature: ______________________________________________ print name: _____________________________________________ address: _______________________________________________ _______________________________________________ home phone: ( ) ______________________________________ office phone: ( ) ______________________________________ e-mail address: (optional) _________________________________ Consent given to post on LIFR Web Site: Yes [ ] No [ ] |
Family Application must be signed by each Family Member or Guardian, as applicable.
Dues: Individual
$40.00
Family (Including children under 16 yrs) $45
Junior (Under 18 yrs) $15.00