Backcountry Hiking Club
Membership Application
Please print, fill out and mail completed application to:
Backcountry Hiking Club, P.O. Box 54673 Phoenix, AZ 85078-4673
(Please note: All information will be will be for club use only.)
   

(   ) $10.00 Single membership (annually)
(   ) New member
(   ) $15.00 Family membership (annually)
(   ) Renewal
(Make check payable to "Backcountry Hiking Club")
(   ) Address change
(Print clearly)
Name ________________________________________________________________________
 
Address ______________________________________________________________________
 
City _______________________________ State ___________________ ZIP _______________
 
Telephone: Home (____)_________________________ Office (____)______________________
 
E-mail address _________________________________________________________________
 

You may list:    My home Tel.(   )    My office Tel.(   )   Email (   )   None! (   ) in the club roster.
 
For family membership, please list the names of all family members who might attend club hikes.

______________________________________________________________________________
 
______________________________________________________________________________
 
Are there any medical problems you or a family member may have that might affect your ability to participate in club activities?
______________________________________________________________________________
 
I hereby release and hold harmless, the Backcountry Hiking Club, as well as its officers, event leaders organizers, sponsors, affiliates and participants for any and all claims, causes of action, or liabilities out of my participation in any Backcountry Hiking Club event. I further acknowledge that there is inherent risk of bodily harm and/or damage in participating in any Hiking event and I agree to assume all risks associated with my/our participation.

Signed __________________________________________________ Date _________________