International Women Fly Fishers
Rendezvous 2010 Salem, Missouri
Friday, May 14 – Sunday, May 16, 2010

Name:______________________________________________________________________________

Address: _____________________________________________________________________________

Phone: ___________________________ Email: _____________________________________________

Club Affiliation: ________________________________________________________________________

Dietary Restrictions: ____________________________________________________________________

Emergency Contact Name & Phone: _______________________________________________________

I am a beginner_____ Intermediate _____ Advanced _____ fly fisher.

I am a current (2010) IWFF member - $85_____ I am a new member of IWFF - $110_____

Note: The registration fees cover the cost of two dinners, one breakfast, and all events.

Each attendee is responsible for payment of their room and board.

In consideration of participating in International Women Fly Fishing activities and/or events, I hereby indemnify and hold harmless International 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 of reproduction by International Women Fly Fishers of photographs taken of me, or my minor children, at the International Women Fly Fishers 2010 Midwestern 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.

Submission of this form and payment of the non-refundable registration fee is required. Each attendee must book their room reservation at Montauk State Park. For all who have pre-registered, it is not necessary to re-confirm your room reservation.

By signing this form you agree to all terms set forth regarding the waiver of liability/photograph release and non-refundable registration fee.

Date: _________________________ Signature: ___________________________________________