|Application Date:||Referred By:|
|All Candidates (check (x) one):||[__] New Member||[__] Renewal|
|Membership Type (check one):||[__] Regular $25.00||[__] Retired $20.00||[__] Associate $25.00||[__] Family $30.00|
|Annual dues payable after the first of each year|
|M/S:||Boeing Phone:||Home Phone (optional):|
|if Family membership, 2nd [__] Name:|
|if Family membership, 3rd [__] Name:|
|if Family membership, 4th [__] Name:|
|if Family membership, 5th [__] Name:|
|Please provide active NRA Membership ID Number:|
|ACTIVE NRA MEMBERSHIP IS REQUIRED TO JOIN BERPC. $35 1ST YEAR Annual|
|NRA memberships available for $25 through Dillon Precision at (1-800-223-4570).|
|How did you hear about us:||___ Boeing News||___ Friend||___ Web Page||Other: _______________|
|Applicant Interests and Requested: Speakers, Events, Information, Classes, ...|
|What activity, feature, event, ... most motivated you to join ?|
|CLUB OFFICER USE ONLY|
|Type||Amt Pd||Card Iss||Tckt Iss||Ad'l Tks|
I state that I wish to participate in activities offered by the Boeing Employees Rifle and Pistol Club, (hereinafter referred to as "Rifle and Pistol Club") a Boeing Recreation Club.
I RECOGNIZE THAT ANY RIFLE AND PISTOL CLUB ACTIVITIES MAY INVOLVE CERTAIN DANGERS. I certify that I am aware of all the obvious and inherent dangers of rifle and pistol activities, including but not limited to, misuse of firearms, malfunction of firearms, of equipment, improper handling of firearms, inexperience, accidents of illness in areas without medical facilities, and the actions of any other club members, any participants or any other persons all of which may result in personal injury, death, property damage and other losses. The Rifle and Pistol Club is a non-profit corporation registered in the state of Washington and all dues and donations are non-refundable.
In consideration for the right to participate in the Rifle and Pistol Club activities, I HEREBY RELEASE THE RIFLE AND PISTOL CLUB AND ITS INSTRUCTORS AND MEMBERS, AND THE BOEING COMPANY FROM ANY AND ALL LIABILITY, CLAIMS AND CAUSES OF THE ACTION ARISING OUT OF OR IN ANY WAY CONNECTED WITH MY PARTICIPATION IN ANY RIFLE AND PISTOL CLUB ACTIVITIES. I PERSONALLY ASSUME ALL RISKS IN CONNECTION WITH THESE ACTIVITIES, AND FURTHER AGREE TO INDEMNIFY THE RIFLE AND PISTOL CLUB AND ITS INSTRUCTORS AND MEMBERS, AND THE BOEING COMPANY FROM ALL LIABILITY, CLAIMS AND CAUSES OF ACTION WHICH I MAY HAVE ARISING FROM MY PARTICIPATION IN CLUB ACTIVITIES. The terms of this agreement will serve as a release and indemnity agreement for my heirs, personal representative, and for all members of my family, including any minors.
I further state that I am eighteen (18) years of age or older and legally competent to sign this release, that I understand these terms are contractual and a mere recital, and that I have signed this document as my own free act. (Parents or legal guardians must sign for all persons under eighteen (18) years of age.)
I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS RELEASE
AND INDEMNIFY BY READING IT BEFORE I SIGNED IT.
Everyone over 18 years of age must sign, date and print name on the release. Applicants must sign and submit a current Release & Indemnity Agreement.
|Signature||Signing Date||Printed Name ..................................................................|
Make checks payable to: BERPC
Mail applications, release forms, & checks to: Seb Pierini , P.O. Box 3707, M/S OR-EU , Seattle, WA 98124-2207
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