Membership
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Membership Form
Send
Completed form to:
Bill Shankle
17 Dunhill Rd
Jackson, NJ 08527
2012-2013
MEMBERSHIP FORM
DVPS Dues: ___ $20 Individual ___ $25 Family** ___ $18 Student
**(If you chose a Family membership would you please
indicate ___ # of Adult and ___ # of Children)**
Additional: $ ______ I'd like to make a contribution to the Paul Bond Scholarship
Fund
Total Payment $ ________
PLEASE PRINT!
Names(s)
_____________________________________________________
Address
_____________________________________________________
City __________________________
State ____ Zip ______________
Country (other than US) _________________________
Phone (H) ________________
Work _________________Cell Phone____________________
e-mail address: ________________________________________
Email delivery of the club's newsletter is
default method and is highly recommended, if this is not possible, please
___ Check this space if you want a paper copy.
___ Check this space if you do not want your information placed in our
Membership Directory.
Delaware Valley Paleontological Society Field Trip Release Form for 2012-2013
The undersigned, in consideration of the
privilege of attending field trips related to the collection and/or study of
fossils, or any other event or activity conducted or hosted by the Delaware
Valley Paleontological Society (DVPS) , such trips,
events, and activities hereinafter being referred to individually as
"Field Trip" and collectively as "Field Trips", hereby
release the DVPS and all officers, Field Trip Leaders and members of the DVPS
from any and all liability with respect to injury to person or property of the
undersigned, free from cause whatsoever, which may occur while the undersigned
or said's children are
attending or
participating in any Field Trip.
The undersigned hereby acknowledges his/her understanding that fossil
collecting is an inherently dangerous activity which can result in serious
bodily injury or death,
and hereby confirms his/her voluntary assumption of the risk of such injury or
death. The undersigned agrees to comply with any and all rules and restrictions
which may be communicated to the undersigned by the DVPS and/or landowner with
respect to the Field Trip. This release is being signed with respect to
all Field Trips conducted by the DVPS, until such time as the undersigned shall
revoke this Release by written notice to the President of the DVPS.
IN WITNESS WHEREOF, and intending to be legally bound, the undersigned has signed this Release.
Name _________________________ Signature __________________ Date ________
Name _________________________ Signature __________________ Date ________
Name _________________________ Signature __________________ Date ________
Name _________________________ Signature __________________ Date ________
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