MBC MEMBER FORM 2019


NAME……………………………………………………… DOB…………………………………………………

EMAIL……………………………………………………… MOBILE…………………………………................

ADDRESS……………………………………………………………………………………………………….............


MBC membership fee is $55.00 per person, to be paid before entering event competitions

$10 Division entry on event days. NO PAYMENT-NO COMPETION

MEDICAL DETAILS

Emergency Contact Name………………………………….. PH…………………………………………………..


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I hereby give permission for officials of the Mandurah Bodyboard Club to seek any medical service that I may require. Parent/Guardian signature (if under 18yrs) x…………………………………………………………………………………………………………


CODE OF CONDUCT


COMPETITOR WAIVER

In applying to become a Mandurah Bodyboard Club member I acknowledge that there are inherent dangers associated with the sport of bodyboarding and my participation in the event and that serious accidents can and do often occur which may result in me being injured. To the full extent permitted by law, I agree to ABSOLVE AND INDEMNIFY the Mandurah Bodyboard Club, committee members and associated sponsors from all claims that I may have or may have had but for this release arising from my participation in the event for the purposes of promoting the Mandurah Bodyboard Club, their programs and events and associated sponsors. I agree to the release of all official photographs and video footage taken during this event, and its use by the Mandurah Bodyboard Club and associated sponsors.


It is an expectation that one person from the members family is available to assist in events



DIRECT CREDIT:

The Mandurah Bodyboard Club Inc.

BSB: 036-157 Account Number: 458567 Reference: Your Name

ONLINE www.surfingaustralia.com/clubs/mandurah-bodyboard-club


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OFFICE USE ONLY


DATE


Amount Paid




Payment Method


Signed up by: