[HOME]                       APRIL is membership month, club dues need to be renewed each April.

Also, ALL members MUST sign a NEW waiver EACH YEAR before diving club events/dives, etc.

[Print page out, fill it form, sign it, include a check, mail it - DONE!  Welcome to the Club!]

Auburn Skin Divers Association - Membership Application & Release of Liability


Name: __________________________     Home Phone: ________________________


Address:    _______________________________    *Cell#: ______________________


            City/St/Zip: ______________________    *Print cell# on buddy list __Yes _No


  E-Mail: ______________________________________________________


Birth month & day: _______________/______
  Work Phone: ________________


Additional Member/Spouse Information (Non-Diver)


Name: __________________________________ Work Phone: ___________________


Email Address: ________________________________ Cell#: ____________________
OPEN WATER Certification ...


Date: ________________ Agency: __________________________________________
* List higher levels and specialty courses on the back of this form [if desired]
Specialty Course, you would like listed with your name on the Buddy List

__________________________________________

RELEASE, WAIVER and HOLD HARMLESS
Auburn Skin Divers Association is a club that is formed of friends and fellow divers who participate in activities together. THE MEMBER AND ANY GUESTS OF THE MEMBER

ASSUME ALL RESPONSIBILITIES DURING THIS TIME. It is up to the member to judge their readiness or ability for any diving related activity. It is also up to the member

and any guests of the member not to put themselves in any situation or any place that they  feel may cause danger or harm to themselves.

At no time is  the club or any person associated with the club responsible for the member's or their guest's decisions or injuries.

The member has and hereby does assume all risk and will hold harmless both the club and all members associated with the club from any liability claimed by the member,

or the member's guests and the member's estate, and the estates of any guests of the member, while the member, or guests,

participates in whatever activities they and they alone decide are appropriate for themselves. The provisions of this Release, Waiver,

and Hold Harmless shall survive the death or incapacity of the member and their guests

and shall be binding upon the member's estate, and the members guest's estates, and shall claimants, heirs, and devisees who claim through those estates.

I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THE RELEASE, WAIVER AND HOLD HARMLESS BY READING THIS DOCUMENT BEFORE I SIGN.

I UNDERSTAND THAT THE TERMS HEREIN ARE CONTRACTUAL AND I HAVE WAIVED ALL RIGHTS TO LIABILITY.


Signature:________________________________________________Date: ____________


Witness: _______________________________________________Date: ____________

Annual Membership Rates [April to April]: New or Renewing Individual - $30.00 New or Renewing ... Family - $35.00


Amount Enclosed: $_________; Date:____/____/____

Please make checks payable to: Auburn Skin Divers Association, c/o: Diana O'Brien, 4532 Route 38A, Skaneateles, NY 13152