| Application for Membership Please print form, fill in and post to the address shown at the bottom of the page. To print this form; right click and select print. Alternatively go to File in the top left hand corner and find print in the drop down menu. |
| Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Post code . . . . . . . . . . . . Occupation. . . . . . . . . . . . . . . . . . . . . . .Date of Birth . . . . . . . . . . Telephone; Home: . . . . . . . . . . . . . . . . .Mobile: . . . . . . . . . . . . . . |
| Please list any other Waterski Clubs you are a member of: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
| Type of membership required (please tick): Single . . . . . . Junior . . . . . . Family* . . . . . Senior Citizen . . . . . (* add full names and ages of all persons to be included) |
| Declaration If my/our application is accepted, I/we hereby agree to absolve the Club, its Officers, Servants, Agents and Members from any liability for death or bodily injury, or any other loss or damage arising, in respect of myself/ourselves and/or my/our child(ren) from any cause whatsoever, whilst engaged in the activities of the Club. |
| Signed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Date . . . . . . . . . . . . . . (to be signed by all applicants - parent/guardian for minors) |
| Please Post To: Tony Coghlan Secreatry, Dudley Water Ski Club, Lodge Farm Reservoir, Highbridge Road, Netherton, Dudley, West Midlands, DY2 0HB |