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Elmhurst Ski Club - Membership Profile

2004-2005

                                                                                                               Dues Paid: $20____________

 

Name: ______________________________________________________________________

 

Address: ______________________________________________________________________

 

City: _____________________________State: _________Zip: ___________________________           

 

Home Phone: ___________________________Cell Phone: __________________________________

 

Business Phone: ____________________Email Address__________________________________                    

 

                           Never                            Novice                      Intermediate                Expert

Ski Ability:              0                      1 2 3                             4 5 6                       7 8 9                

(Circle One)

 

Room Preference for Trips   ___________ Non-Smoking          ________Smoking

 

I am interested in helping the Elmhurst Ski Club for the following;

 

____________   Membership                           __________ Special Events

____________   Newsletter                             __________ Trips
 
____________   Publicity                                 __________ Other ______________________

 

How did you hear about the Elmhurst Ski Club? _______________________________________

 

Agreement:

 

            I agree to maintain the standards and reputation of the Elmhurst Ski Club and to follow the directions of its leaders.  I hereby release the Elmhurst Ski Club and its agents and officers of any and all responsibilities or liability of any nature whatsoever for any loss of property or personal injury occurring on any trip under its management or with any activity or function related to the Elmhurst Ski Club.  I certify that I have read and understood this agreement.           _____ initial here.

 

Signed: ___________________________________________

 

Date_________________

 

 

Optional Information:

 

     Occupation ________________________________________________________________________

 

     Birthday ____________________  ______            Anniversary _________ _________ _________

                        Month                     Day                                    Month                 Day               Year

 

Please return this form with dues to:

Rick Burke, 280 Springfield Terrace, Des Plaines, IL 60018

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