membership ... monroe y ski club

Membership Application

Please Note: YMCA membership is not requiredfor membership in the ski club.

If you find that you do not trust the Internet (and the inevitable evil little people hiding in its every dark pathway) and would rather fill out a printed form and send that instead with your check, which is fine, please use this form or download this Word .doc.

Membership Dues: (choose one of the following)

$24 per person or $22 per person if you ran a board-approved event.
$34 per married couple or $32 if you ran a board-approved event.
$12 per person for members who live 50 miles or more from Rochester.

First Name:

Date of Birth:

Last Name:

Middle Initial:

Spouses Name:

Date of Birth:

Street Address:

City:

State:

Zip:

E-mail Address:

Membership type:

New
Renew
Affiliate

Home Phone:

Work Phone:

Ext:

I do not want my [ Home] or [ Work] or [ Both] phone numbers published in the club directory.

How did you hear about the MYSC?

Will you work on an event?

Yes
No

What kind of event would you work on?

Downhill Skiing
Cross-country Skiing
Social
Other:

Any member or guest of the Monroe "Y" Ski Club participating in any activity promoted and/or sponsored by the Monroe "Y" Ski Club shall not in any manner hold the Monroe "Y" Ski Club, Monroe YMCA, it's officers, or members responsible for any lost articles, accident, or injury resulting from said activity. I, by submitting this form, hereby state that I am over 21 years of age and I have read the foregoing agreement and understand it completely and agree to its terms.

Please give us the name of someone we can telephone in case of an emergency.
(NOT a roommate or spouse if they will be with you at an event)

Name:

Relationship:

Telephone:

City, State:

Please note: Your membership will not be active till your check is received.

SEND YOUR CHECK (payable to MONROE Y SKI CLUB) TO:

Monroe Y Ski Club
c/o Peter Yochim
247 Chapel Hill Drive
Rochester, NY 14617-2922

Phone: 585-544-0601

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