BSKC Membership Application

BOSTON SEA KAYAK CLUB

MEMBERSHIP APPLICATION NEW ______ RENEW ______

Dues for both new and renewal memberships are $10 single or $15 for a family all residing at one postal address and, if used, a single email address.

TO JOIN: Please print this form then read and sign the "Assumption of Responsibility and Release of Liability" statement, fill out the information requested, and mail the form and a check payable to Boston Sea Kayak Club, or BSKC, to:

Townsend Barker, 191 Allerton Road, Newton, MA 02461
TO RENEW: Although you may have an old membership form on file please sign and return a new form with your current data so we may update our records, and mail a check as above.

ASSUMPTION OF RESPONSIBILITY AND RELEASE OF LIABILITY WAIVER I knowingly, voluntarily and willingly, on behalf of myself, my heirs and executors, take full responsibility for my personal safety and well-being while participating in any sea kayaking activities with the Boston Sea Kayak Club,Inc. and any of its members, and waive any claim against the Boston Sea Kayak Club, Inc. and any of its members for any injury, including death, or damages to my equipment resulting from such participation. I understand that sea kayaking is a potentially dangerous activity and assume sole responsibility for deciding if my experience, skills, condition and equipment are sufficient for my safe participation. I further understand that sea kayaking can be a strenuous activity and assume sole responsibility for insuring that I am in good enough health and physical condition for my safe participation.

Each single member and each member of a family please sign below.

Signature(s)_________________________________/______________________________Date____________

Please print clearly to avoid problems with your membership

Names(s)(please print)___________________________________/____________________________________

Address__________________________________________________________________________________

City__________________________________________________State_____________Zip________________

Email/Internet address_______________________________________________________________________

Home Phone(______)____________________________________

Kayak________________________________________________

Do you want your name/address made available to outfitters for promotional mailings? Yes_____ No______

Please indicate your judgment of your skill level: (For detailed explanations go to www.bskc.org/events.php)
_____ Novice: Minimal experience in wind and waves or minimal rescue practice.
_____ Beginner: Some experience in moderately difficult conditions and can assist with rescue.
_____ Experienced Beginner: Some experience in moderately difficult conditions and some rescue experience.
_____ Intermediate: Considerable experience in challenging conditions and considerable rescue experience.
_____ Advanced: Extensive experience in very challenging conditions; also in self and group rescues.

Comments:________________________________________________________________________________________

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