Elmhurst Ski Club - Membership Profile

2006-2007

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:

Christy Burke

280 Springfield Terrace

Des Plaines, IL 60018