Application For Family Membership In The

North Shore Erie Amateur Astronomers

(one way to print this form is just press CTRL + P together)

Date: ___________________

Names: __________________________________________________

___________________________________________________________

Address: _________________________________________________

____________________________________________________________

Phone: ________________________Email: _________________________

Payment of $ 25.00 payable to North Shore Erie Amateur Astronomers covers

a period of one year from the date given above.

Please mail this application form and cheque to club treasurer Bernd Mueller, Box 128, Vittoria, ON, N0E 1W0 or better still bring them to our next meeting.

I/we hereby apply for membership in the North Shore Erie Amateur Astronomers for the period stated above. I acknowledge and agree that there are certain risks associated with Club activities such as attendance at observation nights, field trips and other Club sponsored events.

I therefore shall release and forever discharge North Shore Erie Amateur Astronomers, all of its members, past and present, all agents assisting the Club from any liability for injury or loss arising from my presence at the Club’s events.

I consent that my phone number and email address, if given above, may only be revealed to other club members.

Signed: ______________________________________________________