SIGN ME UP!
I want to join the Salt City Rollers for 1999

____ Individual membership $15.00

____ Family membership      $20.00

Your mailing address:

Street:  ____________________________________________________________

City_________________________State/zip_______________________________

e-mail:  ______________________

Telephone numbers:

home (_____) _______________

work (_____) _______________

Make check payable to:    SALT CITY ROLLERS

and mail to:    SALT CITY ROLLERS IN-LINE SKATE CLUB
                     P. O. BOX 432
                     LIVERPOOL, NEW YORK 13088

I, the undersigned, know that in-line skating is a potentially hazardous activity.  I will not enter and skate in any Salt City Rollers (aka The In-Line Groove Skate Club) activity unless I am medically able and properly trained.  I have been warned that I should wear protective gear, including a helmet, wristguards, and elbow and knee pads.   I assume all risks associated with skating in Salt City Rollers (aka The In-Line Groove Skate Club) activities including, but not limited to, the following:  falls, contact with other skaters, pedestrians, cars, or other objects; the effects of weathers, including extreme cold, high heat and/or humidity; the conditions of the road and traffic on the course, all such risks being known and appreciated by me.  Having read this waiver and knowing these facts, and in consideration of your acceptance of my application for membership, I for myself and anyone entitled to act in my behalf, waive and release the Salt City Rollers (aka The In-Line Groove Skate Club), Club officers, all sponsors, their representatives, and successors from all claims and liabilities of any kind arising out of any participation in Salt City Rollers (aka The In-Line Groove Skate Club) events.
 

 __________________________________             age: ____         sex:  ____
Printed name

__________________________________             ability:  ____
Signature

ABILITY:    1 = LOW,    5 = HIGH
 
 

Additional family members:
(A parent's signature is required for family members under the age of 18)
 
 

__________________________________             age: ____         sex:  ____
Printed name

__________________________________             ability:  ____
Signature
 
 

__________________________________             age: ____         sex:  ____
Printed name

__________________________________             ability:  ____
Signature
 
 

__________________________________             age: ____         sex:  ____
Printed name

__________________________________             ability:  ____
Signature
 
 

__________________________________             age: ____         sex:  ____
Printed name

__________________________________             ability:  ____
Signature