Betty's Outrageous Adventures: Registration Form

BOA Registration Form

Please print clearly:

Name: ______________________________________
Address:
__________________________________________
__________________________________________ Birth date: _____/_____/___________
Occupation: _____________________________
Contact Tel: (______)_______-__________
Contact E mail: _____________________________

Emergency Contact Name:
___________________________________________
Tel: (______)_______-__________

I Prefer:
Daytime Events: _____
Evening Events: _____
I have no preference: _____
On which day are you interested in participating in activities?
M___ T___ W___ Th ___ F___ Sa___ Su___

Please check mark the leadership role's you are interested in.

Marketing Committee____ Electronic Communications____ Finance Committee ____

Sport Referee____ Instructor / Teacher____ Registration Committee____

Series Organizer _____ Trip Leader____ Community Networking ____

Cleanup Committee____ Specify other: ________________________________

Do you possess any First Aid knowledge and if so please specify:
________________________________________

Waiver and Participation Agreement:
I am aware that my participation in BOA may involve potential risks of injury and I am voluntarily participating in such activities with that knowledge. I acknowledge that I will use my own best judgment to avoid injury to myself and others. I agree to abide by the rules of locations of BOA activities. In consideration for BOA's membership services, I release BOA, including its board of directors, officers, activity leaders, or other BOA representatives, from any liability for injuries to my person or property resulting from my participation in BOA activities. I further agree to hold harmless and indemnify BOA and said representatives against any claims, liabilities, lawsuits, attorney fees, or costs to which they may be subject due to my acts or omissions in connection with BOA activities.

Your signature in agreement: ___________________________________________________

Can we give out your contact numbers and activity interests to other BOA members on our group contact sheets for the group's information only?
Tel: Yes__ No__
Email: Yes__ No__

Name: ______________________________________ Address: __________________________________________ __________________________________________	Birth date: _____/_____/___________ Occupation: _____________________________ Contact Tel: (______)_______-__________ Contact E mail: _____________________________

Emergency Contact Name: ___________________________________________	Tel: (______)_______-__________

I Prefer: Daytime Events: _____ Evening Events: _____ I have no preference: _____	On which day are you interested in participating in activities? M___ T___ W___ Th ___ F___ Sa___ Su___

Marketing Committee____	Electronic Communications____	Finance Committee ____
Sport Referee____	Instructor / Teacher____	Registration Committee____
Series Organizer _____	Trip Leader____	Community Networking ____
Cleanup Committee____	Specify other:	________________________________