Start enjoying the fun of being part of the Gang!
| Full Name ______________________________ | Spouse's Full Name _____________________ |
| Nickname* _____________________________ | Nickname* ___________________________ |
| Home Address __________________________ | Date of Birth __________________________ |
| City _______________ State/Zip ___________ | Emergency Contact _____________________ |
| Date of Birth ____________________________ | Address ___________________________ |
| Home Phone ( ) _________________________ | __________________ Phone __________ |
| E-mail Address __________________________ | |
| * Will be used on a name tag with family name | AREAS OF INTEREST (Check all that apply) |
| Skiing: ( ) Down Hill, ( ) Cross Country | |
| MEMBERSHIP TYPE (Check Choice) | ( ) Golf ( ) Hiking ( ) Canoeing |
| ( ) Individual membership $25 | ( ) Cycling ( ) Tennis ( ) Sailing |
| ( ) Combined Spouse Membership $40 | ( ) Other _____________________________ |
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The undersigned hereby assumes all risks inherent in, or arising out of any and all activities releated in any way to this membership. The undersigned likewise releases and forever holds harmless the Top of the Hill Gang, its officers, board members or members from any claims arising out of any activity related in any way to the membership. Signature of Applicant __________________________ Date _______________ Signature of Spouse ____________________________ Date _______________ |
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Please mail to TOHG |