Membership Registration Form

This form is for new member and renewal registration. It is important that you provide the requested information in order to assure that your request is handled in a timely manner. Please fill-out and print this for, then select "Register" to send the information. Send the form in with your check to our P.O.Box listed below. Memberships are annual and non-refundable once accepted.

First Name:
Last Name:
Street:
City:
State:
Zip Code:
Home Telephone:
Work Phone
FAX:
E-mail:
Birth Date:
Other Information:	Male Female Single Married
Name to appear on membership badge

I would like to participate in the following committees:

Ski	Racing	Membership	Tennis
Volleyball	Social	Ways & Means	Public Affairs
Computer	Golf	Directory

Ski Experience:

None	Beginner	Novice
Intermediate	Advanced	Expert
Interested in Racing

Please make out all checks to Balboa Ski and Sports Club or BSSC
Mail to:

Balboa Ski and Sports Club
PO Box 8288,
Newport Beach, CA 92658-8288

Supply the following payment information:

Check Number
Amount Paid
Credit Card


Please use this box for additional comments you wish to make:

Release of Liability

In consideration of the BSSC's acceptance of my membership and renewal thereof, and for other good and valuable consideration, I, on my behalf and the behalf of my legal representatives, including my spouse, if any, and insurers, do hereby waive, release and forever discharge the BSSC, its officers, directors, employees and agents including but not limited to activity leaders, of and from any and all claims, loss, cost, damage to property which I may sustain as a consequence of the negligence of any such entity or person in connection with or related to any activity arranged, organized, sponsored or managed by BSSC, including transportation to and from such activity.

I understand that the BSSC will not accept my membership unless I sign or check 'Accept' of this Release, which I have read and to which I voluntarily agree.

Signature __________________________ Date __________

Form Submission

Use the Print function of your Browser to print a copy of this form to send in, Then click on Register below to Email the form.

Membership Registration Form

Release of Liability

Form Submission

Revised: March 19, 2008.