Etobicoke Camera Club

 

Membership Application/Renewal - 2009-2010 Photographic Season Click here to download and print the Membership Application/Renewal form (pdf) Waiver:  Members are required to sign an outings waiver which is included in with this Membership Application/Renewal.  Please print out these forms and bring them with cash or cheque to a meeting.

 

Membership:	Annual Fee	Donation (optional)	Total
Couple:	$80.00
Single:	$60.00
Student:	$15.00

 

Name(s)
Address
City		Postal Code
Phone:	Home (       )	Business (      )

 

E-Mail

 

Where did you learn about the E.C.C.?	Camera Store?
	Friend?
	Internet?
	Another Club?
	Other?

 

 

Please make cheques payable to: Etobicoke Camera Club

 

Privacy Statement: The membership list is kept within the club and is not shared with any

third party.  However, the membership list (including e-mail and phone but excluding home address) is shared internally with other club members.

Please check the appropriate boxes below to indicate your privacy preferences.

1    include e-mail                or            1  exclude e-mail

    1    include phone #             or            1  exclude phone #

 

Date:  _____________________  Signature:  ___________________________________

 

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Waiver and Assumption of Risk

 

 

I affirm that, by participating in any outing conducted by the Etobicoke Camera Club, I am fully accepting as my personal risk any and all consequences of such participation, and I hereby agree to release, save harmless and indemnify the Etobicoke Camera Club, its officers, directors, agents and members from and against all claims, actions, costs and expenses in respect to death, injury, loss or damages to me or my property arising as a result of my participation.

 

In the event of an accident or medical problem suffered by me, I consent to the Etobicoke Camera Club seeking out the appropriate medical care required.

 

I declare that I have read and fully understand this Waiver and Assumption of Risk, and that it is binding on my, my heirs, executors, administrators and assigns.

 

 

Date:  _____________________  Signature:  ___________________________________

 

                                            Print Name:  ___________________________________