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Name: ______________________________________________________________
Address: ______________________________________________________________
Phone: ______________________________________________________________
Email: ______________________________________________________________
Club Affiliation: __________________________________________________________
Dietary Restrictions:_____________________________________________________________
Emergency Contact Name & Phone:_________________________________________________________________
I am a beginner ___ intermediate ___ advanced ___ fly fisher.
I am a current IWFF member-$90 ___ I am a new member of IWFF-$115___ [(Includes IWFF Membership)
Note: The 90.00 registration fees cover the cost of two dinners, two lunches, and all events.
Breakfast is included in your Mt. Shasta Ranch B & B accommodations. Each attendee is responsible for payment
of their own room and board.
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 2010 Mount Shasta Regional Rendezvous. 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.
Please forward check payable to IWFF and this form to:
Judy Brandi 821 Rae Lane, Novato, Ca 94947 – space is limited
Submission of this form and payment of the non-refundable registration fee is required . Each attendee must book their own room reservations at Mount Shasta Ranch Bed and Breakfast, or another location if there is no room at Mount Shasta B & B. For all who have pre registered, it is not necessary to re confirm your room reservation.
Any IWFF attendee that is booked at the Mount Shasta Ranch Bed & Breakfast is responsible for their non refundable room fee. The Mount Shasta Ranch Bed & Breakfast rents out the whole place to IWFF and IWFF is therefore liable for all room reservations for the three days.
By signing this form you agree to all terms set forth regarding the waiver of liability/photograph release, non refundable registration fee and non refundable three day room fees at the Mount Shasta Ranch Bed and breakfast.
Registration Deadline: January 15, 2010
Dated________________ Signature_________________________________________ |