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www.easttexasatv.com
Membership Application Form
Please fill out and return
Date _______________
NAME: ____________________ BIRTHDAY--Month: _____ Day: _____
Please Print
MAILING ADDRESS: ___________________________________________
CITY: _________________________ STATE: ______ ZIP: ______-______
HOME PHONE: ______________ WORK PHONE: __________________
CELL PHONE: ____________________
E-MAIL: _______________________________
Please list any additional on separate sheet of paper
About your rides:
1___________________________________________________________________________
2___________________________________________________________________________
3___________________________________________________________________________
4___________________________________________________________________________
5___________________________________________________________________________
Please list any additional on separate sheet of paper
ADDITIONAL MEMBERS OF YOUR FAMILY
Significant Other: _________________________ BIRTHDAY—Month: ______ Day: ______
NAME: _________________________________ BIRTHDAY—Month: ______ Day: ______
NAME: _________________________________ BIRTHDAY—Month: ______ Day: ______
NAME: _________________________________ BIRTHDAY—Month: ______ Day: ______
Please list any additional on separate sheet of paper.
READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECT IS TO
RELEASE THE EAST TEXAS ATV ASSOCIATION FROM ANY LIABILITY
RESULTING FROM YOUR PARTICIPATION IN THE BELOW-NAMED ACTIVITY
AND WAIVES ALL CLAIMS FOR DAMAGE OR LOSSES AGAINST THE EAST TEXAS ATV ASSOCIATION. RELEASE FROM RESPONSIBILITY, ASSUMPTION OF RISK AND WAIVER. In consideration of my being permitted by East Texas ATV Association to participate in, all activities, rides, or outings in association with East Texas ATV Association at various locations in the United States of America during my membership in this association, I___________________________________, the undersigned member of East Texas ATV Association, exercising my own free choice to participate voluntarily in the above-named activities, and promising to take due care during such participation, hereby release and discharge, indemnity and hold harmless the board members of the East Texas ATV Association and their members, officers, agents, employees and any other persons or entities, (all of such persons and entities are identified below as “Released Parties”) against all claims, demands, causes of action whatsoever either in law or in equity, relating to injury, disability, death or other harm, to person or property or both, arising from my participation in and/or presence at the above-listed activities. I acknowledge that I have been informed of major hazards and risks which may include sprains, strains, dislocations, amputations, cuts, bruises, breaks, teeth (loosened/broken/knocked out), head injuries, paralysis, death, travel and other risks normally associated with my participation in the above-named activities: I understand, accept, and assume those hazards and risks and waive all claims against the board members and East Texas ATV Association, several limitations and exclusions exist with respect to liability of the Released Parties. Therefore, I have determined whether I have adequate separate personal insurance to cover all harm that I may suffer due to participation in this activity and I have obtained all insurance protection that I want. I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound to them. After careful deliberation, I voluntarily give my consent and agree to this Release, Assumption of Risk, and Waiver.
SIGNED_____________________________________________DATE______________
SIGNED_____________________________________________DATE______________
SIGNED_____________________________________________DATE______________
SIGNED_____________________________________________DATE______________
SIGNED_____________________________________________DATE______________