Membership_App – Stark County Ski Club

Stark County Ski Club Membership Application

Name *

Second person

Additional family members

Additional family members must share same address

Address *

Country

City

State

Zip code

Primary Email *

Additional/Alternate Email

Primary Phone *

Alternate Phone

Emergency Contact *

Contact Phone *

Select Type of Membership *

Single Membership - Renewal $20

Single Membership - New Member $30

Couple Membership -Renewal $25

Couple Membership - New Member $40

Family Membership - Renewal $30

Family Membership - New Member $45

Membership is from November 1st to October 31st
Family and Couple Membership must share the same mail address.
If you were not a paid member last year you are not a Renewal this year.

Liability Waiver Statement

NOTICE: By signing and/or accepted any membership benefit and/or participating in any club activity, applicant releases Stark County Ski Club, its officers, board members, chairpersons, trip leaders and members from any all liability or any claims including theft, property loss, accident, illness, injury, death of or to themselves, family members or guests arising from participation in any club activity, whether resulting from negligence or otherwise.

Liability Waiver *

By checking this box, you have read and agree to the above mentioned Liability Waiver Statement

Instructions
Make Checks Payable to Stark County Ski Club

Please mail Payment to

Debbie Scherer
355 Beucler Ave. NW
Bolivar, OH 44612

Optional information: For new and existing members, what most interests you about the club and/or what would you like to see us attempt in the future?