TIDEWATER APPALACHIAN TRAIL CLUB
P.O. Box 8246
Norfolk VA 23503

MEMBERSHIP APPLICATION

Web Page Version (Print a copy, fill out and return)

I have read, understood and signed the TATC "Waiver and Release of All Claims" statement on the reverse of this form.

 Date of Application ________________

MINIMUM AGE FOR MEMBERSHIP- 18 YEARS OLD
NAME(S) ___________________________________________________

 Last First (both adults)

ADDRESS ___________________________________________________

 Street/P.O. Box City State Zip

TELEPHONE ___________________(home) ___________________(work)
MEMBERSHIP DUES (Check Appropriate Line)

	Single	Family (two adults)
New Members	____ $20.00	____ $30.00
New Members (After September 1st)	____ $13.00	____ $20.00
Membership Renewals (March - April)	____ $15.00	____ $23.00
Life Membership (One Time Fee)	____ $300.00	____ $460.00

Note: Members who do not renew their membership between March 1st and April 30th will be considered as new members and will be required to pay new member dues. Yearly membership is from March 1st through February 28th.

I AM INTERESTED IN THE FOLLOWING (check as many as desired):

_____	Hike/Trip Leader	_____	Local Area Trails Committee
_____	Trail Maintenance	_____	Membership Committee
_____	A.T.Land Management Committee	_____	Publicity Committee
_____	Cabin Committee	_____	Program Committee
_____	Club Newsletter Committee	_____	Social Committee
_____	Education Committee	_____	Historical Committee
_____	Display Board Committee	_____

How did you find out about T.A.T.C.? _______________________

CLUB USE ONLY: Signature(s) on Waiver _________
Paid by: Check _____ Cash _____
Date Received by Membership Committee ________
Date Membership Card & Packet Issued/ Sent ________
Date Entered on Mailing List ________

TIDEWATER APPALACHIAN TRAIL CLUB
WAIVER AND RELEASE OF ALL CLAIMS

I know that outdoor activities conducted by the Tidewater Appalachian Trail Club, a Virginia nonprofit corporation, are potentially hazardous. I should not participate unless I am medically able and properly trained and properly equipped. I agree to abide by any decision of an activity leader relative to my ability to safely complete the activity. I assume all risks associated with participating in any activity, including but not limited to, falls, contact with other participants, effects of the weather, including heat and humidity, traffic and road conditions, trail and river conditions, and all other risks, known or unknown. Having read this waiver and knowing these facts and in consideration of participating in an activity, I for myself and anyone entitled to act on my behalf, waive and release the Tidewater Appalachian Trail Club, its officers and directors, volunteers, activity leaders, and co-participants in any activity, their representatives and successors, from all claims or liabilities of any kind arising out of my participation in an activity. I grant permission to all of the foregoing to use any photographs, motion pictures, recordings, or any other record of an activity for any legitimate purpose.

______________________	___________________________________
Date	Participant's Signature
______________________	___________________________________
Date	Participant's Signature

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E-Mail Address

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