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Address ________________________________________________________________ City:____________________________________ State:_____________ Zip:_________ Phone:__________________ Fax:________________ Email: _____________________ Name of Business:________________________________________________________ Address:________________________________________________________________ City:____________________________________ State:_____________ Zip:_________ Phone:__________________ Fax:________________ Email: _____________________ Profession:______________________________________________________________ Club Affiliation :_________________________________________________________ Web Site: ______________________________________________________________ How did you learn of IWFF?________________________________________________ Do___Do not____include my name on the membership roster which will be distributed to the membership of IWFF and is for personal use. Do___Do not____include my name on mailing lists released by IWFF Board of Directors to outside entities associated with fly fishing.
Credit card: ___ Visa ___ Mastercard ___ Discover ___ American Express Card Number:____________________________________________________________________Expiration Date:_________ Authorized Signature:___________________________________ WAIVER OF LIABILITY In consideration of participating in International Women Fly Fishers activities and/or events, I hereby indemnify and hold harmless and release the International Women Fly Fishers, its Officers, Board of Directors, Members and Agents from any and all liability for any injury suffered by myself, or my minor children, arising from or connected with club activities or events. I assume all the risk for any injury received and agree to hold the International Women Fly Fishers free and harmless from any and all costs, expenses and attorneys fees incurred in connection with any action, claim or demand brought thereon. I further agree to abide by all terms and conditions set forth in the club by-laws and regulations. Signature:_________________________________________________________ Date:_____________
Nancy Zakon, President Jodi Pate, 1st Vice President Pat Magnuson, 2ndVice President Chief Financial Officer - Karen Kukolich Secretary - Pudge Kleinkauf
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