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Date: ___________________
TABLELANDS
WALKING CLUB INC.
MEMBER DETAILS
Forward
(cheque enclosed) to:
The Secretary
Tablelands Walking Club
PO Box
1020 Tolga, 4882
Name: ____________________________________________________________
Address:___________________________________________________________
___________________________________ Post Code _______________
Telephone: _______________________________
Fax: ____________________________________
Email: ____________________________________________________________
EMERGENCY CONTACT
Name:_____________________________________________________________
Address: __________________________________________________________
__________________________________ Post Code _______________
Telephone: ______________________________
Relationship:
______________________________________________________
RISK WAIVER
While voluntarily participating in the above walk, I agree to abide by club rules and requirements, to accept directions from the leader, whilst retaining responsibility for my own welfare and that of any children in my care. I understand that I participate in this activity at my own risk. The Club maintains a personal accident and a public liability insurance policy. Any incidents relevant to the policy should be reported to the trip leader or the committee as soon as possible.
Signature:______________________________________
Date:___________________________
Fees: Club memberships are due at the AGM in September each year.
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