Mullica Hill Women's Triathlon Club Registration


Membership runs from January 1st through December 31st, 2014
Membership Fees:  Adult - $40 until April 1st, $50 after; Teen - $25 until April 1st, $35 after

First Name
   
Last Name
 
Address  
 
Address 2
City
 
State
Zip Code
 
Birthdate
Month  Day    Year
     
USAT #
(not required)
Email Address
 
   
Shirt Size
(Women's Cut)

 
Membership Type:
Would you like to donate $3 to help END THE STIGMA associated with mental illness?
Are you a new member?
Waiver: Mullica Hill Women's Tri Club Waiver And Hold Harmless Agreement. Release and Waiver of Liability, Assumption of Risk, and Indemnity Agreeement I acknowledge that by providing my initials, I am releasing Mullica Hill Women's Tri Club and their respective agents, employees, members, sponsors, promoters, and affiliates (collectively 'releasees) from liability. The membership agreement and release is a contract with legal consequences. I have been advised to read it carefully before initially. IN CONSIDERATION of acceptance of this entry or my being permitted to take part in any event of which the Mullica Hill Women's Tri Club is associated with, I for myself, my heirs, executors, administrator, successors, and assigns waive, release, and discharge all claims for damages resulting from death, personal injury, or property damage which I may have, or which hereafter may accrue to me my participation in this event. I understand this release is intended to discharge and release, in advance, the Mullica Hill Women's Tri Club, it's members and their respective agents, and employees from and against any and all liability arising out of or connected in any way with my participation in the event even though that liability negligence or carelessness on the part of the persons or entities mentioned above. I understand that serious accidents occur during bicycling, swimming, running, and related activities. Knowing the risks of participating or being present during a swimming, bicycling, running, or related activity, I, for myself, my heirs, executor, administrators, successors, and assigns hereby agree to assume those risks and release and hold harmless all of the persons or entities mentioned above who, through their negligence or carelesness, might otherwise be liable to me for damages. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM OF AT LEAST 18 YEARS OF AGE AND AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND MULLICA HILL WOMEN'S TRI CLUB AND SIGN IT OF MY OWN FREE WILL. PRIOR TO THIS AGREEMENT'S EXECUTION I MAY CONSULT WITH AN ATTORNEY. FURTHER, I ACKNOWLEGE THAT BY SIGNING THIS AGREEMENT I MAY BE SURRENDERING CERTAIN LEGAL RIGHTS.
Waiver Initials (Parent or guardian initial for children under 18):
 
   



Please make checks payable to "MHWTC" and mail to:
Michelle Powell
1 Woodduck Drive,
Mullica Hill, NJ 08062

  


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