APPLICATION FOR MEMBERSHIP

FIT (Females in Training) Inc.

Name: ...........................................................................................................................................

Address: ........................................................................................................................................

............................................................................................................ Postcode: .........................

Work Ph: .................................................. Home Ph: ..................................................

Fax No: .................................................. E-Mail: ............................................................................

Membership of FIT is open to Females 16 years and over

Emergency Contact:

Name: ........................................................................

Phone: ..................................................

(GROUND EFFECT is a NZ Cycle clothing company with a reputation for quality garments.)

Membership of other Sporting Organisations:

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Areas of Interest:

Please tick areas of interest

Are there any specific types of training or activities that you would be interested in?

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Skills and Resources:

FIT is a voluntary organisation. Are there any areas in which you feel you may be able to help to keep the costs of providing services to our members to a minimum, eg. typing, legal advice, web design, second language?

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Waiver

I hereby certify that I have read this document, including the waiver (printed below) and I understand its contents. I acknowledge that by signing below I accept the terms of the waiver as printed below.

Signature: ........................................................................

Date: ..................................................

Please tick method of payment

Card Number: .................................................. Signature: ..................................................

Name on Card: .................................................. Expiry Date: ...../.....

Waiver

1. I, the undersigned, as a condition of acceptance of my entry in Females in Training (FIT) for myself, my heirs, executors and administrators, hereby waive all and any claim of action which I or they might have for or arising out of my death, disability, personal loss or injury, damage or loss of any description whatsoever which, may suffer or sustain in the course of activities organised by FIT.
   
2. I certify that I am physically fit and have not been advised otherwise by a qualified medical person and have prepared for participation in the training and related activities organised by FIT.
   
3. I hereby consent to receive medical treatment which may be deemed advisable in the event of any injury, accident and/or illness during any activity organised by FIT.
   
4. I understand that membership fees are not refundable upon my leaving FIT.
   
5. I understand that my membership may be revoked at any time if I do not abide by the constitution of FIT.
   
6. I hereby consent to the publication of or use in any form of media whatsoever of my name, photograph, image, statements or otherwise in any context pertaining to FIT whether for advertising, promotion or otherwise.
   

ADDITIONAL INFORMATION

So that we can introduce you to our membership, please provide any information about yourself that may be of interest, eg. how long you’ve been in Canberra, how you heard about FIT, what your fitness aspirations are, what other sports/activities you like to be involved in etc. This information will also be used to assist in future planning of FIT activities.

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For Fit Use Only