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Valley ABATE Application for Membership

Please complete this application, click Print on your browser, sign the application, and send with check or money order to: Valley ABATE PO Box 874872 Wasilla, AK 99687

Select Annual Membership Dues:

Patches?: $5.00

Individual: $15.00

Bi-annual: $25.00

Couple Annual: $25.00

Addt'l Family: $10.00

Name:

Nickname:

Registered Voter?:

Address:

Voting District:

City:

AK ZIP:

Home phone:

Work phone :

Fax:

Alt. phone :

Email:

Reason for joining:

Who told you about Valley ABATE?:

Please read and understand the following agreement and sign below:

By signing this application, I agree to waive any and all claims against Valley ABATE, it's officers, board members and general members for any personal or property loss or damage which may occur as a result of my participation in ABATE functions. I understand that ABATE cannot and will not assume responsibility for my safety and that if I participate in any ABATE sponsored ride or event, I do so voluntarily, and I assume all risks and I release and hold ABATE harmless for any personal injury or damage which may occur as a result of my own or my guests participation in any ABATE sponsored event and I agree to reimburse ABATE for any and all losses it may suffer as a result therefrom.

Member Signature:______________________

Date:

Amount Enclosed:

Application must be signed!


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