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Membership
Application (printable)
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Please
Note: YMCA membership is not required
for membership in the ski club.
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Membership
Dues: (circle one of the following)
x $24 per person or $22 per person
if you ran a board-approved event.
x $34 per married couple or $32
if you ran a board-approved event.
x $12 per person for members
who live 50 miles or more from Rochester.
Last
Name:____________________________________________Date
of Birth:____/____/____
First
Name:____________________________________________Middle
Initial:______________
Spouses
Name:_________________________________________Date
of Birth:____/____/____
Street
Address:__________________________________________________________________
City:___________________________________State:________________ZIP:_________-_____
E-Mail
Address: _____________________________________________
Membership
type: NEW RE-NEW AFFILIATE
(circle)
Home
Phone: ( )______-_________ Work Phone:
( )______-__________ EXT:_____
I
do NOT want my HOME or WORK or
BOTH phones published in the club directory
(circle)
How
did you hear about the MYSC? __________________________________________________
Will
you work on an event? YES ___ or NO___
What
kind of event, Skiing Down Hill or Cross Country or Social:
___________________________
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, the undersigned, 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.
Signed:__________________________________________
DATE:____/____/____
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:__________________________
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Please
note: Your membership will not be
active till your check is received.
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SEND
THIS DOCUMENT WITH 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
Email: MYSCadmn@rochester.rr.com
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