Current Page - Membership Form

 

Please fill out this form and click Submit at the bottom to produce a printable form to bring with you to a meeting.

*Name first
last
Birth Date
My friends call me -
Sex:
Address    
City    
Postal/Zip    
Phone Number -
cell
-
Phone Work -    
*Email Personal    
Employers Name
Occupation:
Membership:    
Membership $10.00/month
Six months ($60.00)  
or one year   ($120.00) 
   
Renewals – 6 months minimum  ($60.00)    
Cash   Cheque    
Amount Enclosed ( to bring to meeting )    
Today's Date    
How did you hear about V.A.S.

   
How many information evenings/events have you attended?    

PLEASE READ CAREFULLY, THIS IS A WAIVER/RELEASE

I hereby certify that I am nineteen years or age or older and I agree to abide by the rules and regulations of the Valley Active Singles Club and to participate in any events or activities sponsored by the Valley Active Singles Club in accordance with their rules, regulations or by-laws.

Upon  acceptance as a member of the Valley Active Singles Club and therefore taking part in any of its events or activities, I hereby, for myself, my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless the Valley Active Singles Club, its representatives or agents for any injury or loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in the events and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of the Valley Active Singles Club.

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