Please provide the following contact information:

*Name
Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Phone
*E-mail

*Emergency Contact Name & Telephone (please include country code)

* I am a current member of International Woman Fly Fishers and/or have renewed my membership to cover  the year of this event. If not Click here to renew your IWFF membership or join.

WAIVER OF LIABILITY/PHOTOGRAPH RELEASE

In consideration of participating in International Women Fly Fishing activities and/or events, I hereby indemnify and hold harmless International Women Fly Fishers, its Officers, Board of Directors, Members and Agents from any and all liability for injury suffered by myself, or my minor children, arising from or connected with club activities and 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 injury, claim or demand brought thereon. I further agree to be bound by all terms and conditions set forth in the club by-laws and regulations.

I further hereby authorize and consent to the use and reproduction by International Women Fly Fishers of photographs taken of me, or my minor children, at the International Women Fly Fishers 2011 Mt. Shasta Rendezvous of Fly Fishing Women.  Any such photographs may be used in the International Women Fly Fishers newsletter, web site, or any other International Women Fly Fishers publications, promotions or educational materials.

*Signed         date      
                          (Please type your name as your electronic signature)   (Please type the date completed)

Registration Fee $70.00 

For additional information and questions regarding this Rendezvous, please contact Wendy at wendybrk@sbcglobal.net or Corol Ann Cary  corolann@gmail.com

 *Required fields for submission of Registration

Revised: 01/01/11