ALTCAMPING MEMBERSHIP APPLICATION for 2002-2003

Fill out completely and mail to: ALTCAMPING P.O. Box 2660 Dearborn, MI 48123-2660

NAME: _________________________________________ Birthdate: __________________

ADDRESS:____________________________City/State/ZIP:____________________________

PHONE(s): _________________________________________________________________

EMAIL: ____________________________________________________________________

Camping Interests:_____________________________________________________________

I'm interested in planning/offering an activity: ___________________________________________

Membership Directory Information (Permission to publish club membership directory including:) * :
My name........................_________.......My Address:......______.......My City/State......________
My phone......................._________.........My Email:........______.........My birthday.......________
I am a: Male........________ or Female:........__________
* note: the membership directory will NOT be sold or shared with anyone other than our paid members.
Unpublished info. is only shared as needed with other board members by the club coordinator, S. Jaynes.

Responsibility Waiver:
Completion of this membership form constitutes acceptance of the following terms of membership:
- I am 21 years of age or older.
- I assume full responsibility for my actions, any guests, and any pets which includes any damages of public or personal property.
- I will not, in any way, hold the membership or coordinators of ALTCAMPING responsible or liable for any actions or inaction associated with any group event, trip, meeting, or activity.
- I will follow all state regulations and/or other campground/facility rules.
- I will not disclose the membership list to outside parties.
- Failure to complete this waiver is grounds for denial of membership.

Name (printed): _________________________________________________

Signature: ______________________________________________________
Each person must complete a membership form.

Emergency information: (Whom to contact, food or other allergies, special conditions, etc.)

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Dues: $25.00 per person minimum donation through 12-31-2003 (effective 4/15/02).
Make checks payable to S.Jaynes or cash only, please.