Masters Series Ski Racing of the Far West, Inc.

Membership Application

All information must be filled out for your application to be valid. You will be charged a late fee if incomplete information causes your application to be filled out after 10/31/08 due date.

Name__________________________________Sex: . Male Female

Date of Birth: ___________________

Address______________________________________________________________

(write “same” if info has not changed)

City/State/Zip: __________________________ Bib Number ____________________

(N/A for new members)

Phone(s): ____________________________________________________________

E-Mail _______________________________________________________________

Membership Dues and Contributions

Renewing New Members

Membership Fee* $20 $20

Lost/replacement bib fee (add $15) _____ N/A

LATE FEE (if postmarked after 10/31/08, add $5) _____ N/A

TOTAL* _____ $20

*Note: do not pay the USSA “Far West” fee unless you want to race or officiate with the juniors

Make Check payable to: Masters Series Ski Racing

Mail to: Marcie Pettigrew

P.O. Box 7181

Mammoth Lakes, CA 93546

Roster Information: You WILL be included unless you specifically say “NO”

YES NO

Is it OK to send news messages to your email address?

Is it OK to print your name and address for members only?

Is it OK to print your name and address for sale to vendors?

For your USSA membership and competition license, please contact the USSA office or visit www.ussa.org

USSA Competition/Masters

P.O. Box 100

Park City, Ut 84060 – (435) 649-9090

____________________________________________________________________________________________________

ACKNOWLEDGEMENT AND ASSUMPTION OF RISK AND RELEASE

I know that alpine, Nordic and freestyle skiing are action sports carrying significant risk of serious personal injury, death or property

Damage. I also know that there are natural, mechanical, and environmental conditions and risks which independently or in combination with my activities may cause property damage, or severe or even fatal injuries to me or others.

I agree that I alone am responsible for: (a) my safety while participating in competitive events and/or training for competitive events and (b) providing, utilizing and maintaining that equipment necessary for the safe enjoyment of my participation in such events and specifically acknowledge that the following persons or entities including Masters Series Ski Racing of the Far West, Inc., United States Skiing, the United States Skiing Association, the United States Ski Team, the United States Ski Coaches Association, the ski area, the promoters, the sponsors, the organizers, the promoter clubs, the officials and any agent, representative, officer, director, employee, member or affiliate of any person or entity named above are not responsible for my safety, even though that liability may arise our of negligence or carelessness on the part of the persons or entities mentioned above. I agree to accept all responsibility for the risks, conditions, and hazards which may occur whether they now be known or unknown.

Being fully aware of the risks, conditions and hazards of the proposed activity as a competitor, coach or official, I HEREBY AGREE TO WAIVE, RELEASE AND DISCHARGE any and all claims for damages for death, personal injury or property damage which I may have or which may hereafter accrue to me as a result of any participation in competitive events or training for competitive events, against any condition of any equipment utilized by me in such competitive events without regard to whether such equipment is specified or recommended by such personas or entities identified above.

I further agree to HOLD HARMLESS AND INDEMNIFY all persons and entities identified above, generally and specifically, from any and all liability for death, personal injury or property damage resulting in any way from my participating in competitive events or training for competitive events.

I currently have, and agree to maintain throughout the time that I train and compete, valid and sufficient medical and accident insurance. I understand that this is my sole responsibility and release all persons and entities identified above from providing coverage to me.

I agree that I will accept and abide by the rules and regulations of the U.S.S.A. and any other rules or regulations imposed by the organizers of any particular competition. This Acknowledgment and Assumption of Risk and Release shall be binding upon my heirs and assign

Date______________SIGNATURE_______________________________________ USSA Number_______________________