Membership Form

Primary Member

First Name:
Last Name:
Address:
City:
State:      Zip:
Home Phone:
Cell Phone:
Work Phone:
Birthday:
Email:
Email Alt:
Occupation:
Company:
Sex :        Male Female

 

 Spouse/SO/OPC*

First Name:
Last Name:
Address:
City:
State:      Zip:
Home Phone:
Cell Phone:
Work Phone:
Birthday:
Email:
Email Alt:
Occupation:
Company:
Sex :        Male Female

*SO/OPC-Significant Other/Other Part of the Couple

Release of personal information
BCSC publishes a membership directory. Would you like your information to be published? (If not, information will only be available to BCSC Board Members)

           Primary Member   Spouse/SO/OPC
                Publish Information   Publish Information
                     Yes           No          Yes           No

Name:
Address:
Home #:
Cell #:
Work #:
Email:
Email Alt:

Monthly Newsletter:
Once the newsletter is made available on the internet, do you wish to continue receiving the monthly newsletter via U.S. Postal Service? (Family memberships receive only one monthly newsletter)
                   Yes   No 

Membership Fees
Individual Renewal $39
Family Renewal $59
Family Upgrade $20

New Members will be prorated depending which month they sign up.

 

Interests, Current and Potential: (check all that apply)

Ski Tennis Swimming Horseback Riding
Race Camping Wine Tasting Motorcycle Riding
Snowboard White Water Rafting Beer Tasting   Other Interests:
Ice Skate Water Ski Bicycle Riding  
Indoor Volleyball Wakeboard Mtn Biking  
Beach Volleyball Hiking Sailing  
Softball Scuba Backpacking  

Release and Waiver of Liability:
In consideration of my participation in the Beach Cities Ski Club, and any and all of its events, and intending to be legally bound for myself, my heirs, my spouse, executors, administrators, and legal representatives, I hereby fully and finally waive, release, and hold harmless Beach Cities Ski Club and its members, officers, board members, appointed group leaders, chairpersons, or agents from any and all liabilities, claims, judgments, or other damages of any nature whatsoever, including but not limited to any personal injuries I might suffer, directly or indirectly resulting from my participation in Club activities.
I attest that I am in adequate physical condition for participation in activities of the Club, and am fully aware of the potential hazards involved, and I hereby agree to accept any and all risks. I acknowledge that I am knowingly executing this Release, and that I do so without any coercion whatsoever.
YES  NO

You will be redirected to pay online after submitting the form.