MEMBERSHIP
APPLICATION & WAIVER
Michigan
Resident: $15.00 per Individual or Family, Non-Resident Fee: $6.00
NAMA Membership:
$32.00 (MMHC membership required)
Name
_________________________________________________________________
Name
_________________________________________________________________
Address______________________________________________ Apt. No._________
City___________________________________
State_____ Zip___________________
Phone_________________________ e-Mail__________________________________
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PLEASE
BE
SURE TO INCLUDE YOUR E-MAIL
ADDRESS IF YOU SELECT ANY ABOVE
MICHIGAN
MUSHROOM HUNTERS CLUB LIABILITY WAIVER
of wild
mushrooms. I realize that mushroom
forays are held in public woodlands where natural hazards do occur,
immediate
medical attention may not be available and the foray leader may not be
trained
in emergency treatment.
I further
understand that people can have known or unknown food allergies and
that people
can experience gastric
disturbances from ingesting wild mushrooms.
In
consideration of this acknowledgement and my voluntary participation in
activities relating to the Michigan
Mushroom Hunters Club (MMHC), having read this waiver
and understanding the risks involved
in participating
in the MMHC events,
and of the agreement by the MMHC to
allow me to participate in its activities.
I
hereby release, on behalf of myself, and my successors, heirs, assigns,
executors, and administrators, the MMHC,
its officers, directors, members and volunteers from any claims
of liability or
demand whatsoever, including but
not limited to bodily injury, sickness,
disease, death, property loss or damage, or any other loss or damage of
any
kind which may arise out of or in connection to my participation in MMHC events, whether resulting from
negligence or from some other cause.
I
have read and understand the forgoing Waiver of Liability, and by
signing below
I indicate my agreement.
It is my intent
to be legally restrained from asserting any claim connected herewith
and I
understand that this
agreement is unconditional and may not be waived by any
person for any reason whatever.
______________________________________ ___________________________________
NAME
:PLEASE PRINT
NAME
:PLEASE PRINT
__________________________________________ _______________________________________
SIGNATURE:
SIGNATURE:
ANTOINE DELAFORTERIE
1970 KIRKTON DR
TROY, MI 48083