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 1224
Palmer, Alaska 99645


Select Annual Membership Dues:   Patches?: $5.00
Individual: $20.00 Bi-annual: $30.00 Couple Annual: $30.00 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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