2011 M.O.M.C. Annual Membership Application

I herewith apply for membership with the M.O.M.C.  I understand that my application is subject to review by the membership committee, and that my membership fee will be returned in the event my application is not accepted.

TYPE OF MEMBERSHIP:
Single ($65)
Family ($90)           *Family includes children and grandchildren 17 years old and younger. 
Senior ($50)           *Seniors 62 yrs and older
Guest  ($15) each    *Guests for which tournaments?       Guest name(s)

SIDE BETS AND ADD-ON CALCUTTA BETS:
Joe LePage ($50)   Homer LeBlanc Calcutta ($50)  Summer Slam ($50)    Joe Pierce Calcutta ($50)    Big Dog Calcutta ($100)

Year End ($20)     Largest Registered Released Muskie ($20)  Captain's Open ($50) 

Name:             Spouse:

Address:

City:     State:        Zip:

Phone:         Email:

Boat make:         Boat name:

Length:    Registration:     Color:

Are you a charter captain? Yes    No

In consideration of the acceptance of my membership, I for myself, and my family, executors, administrators and assignees do hereby release and discharge the M.O.M.C., its sponsors, supporters, officers, directors, volunteers and agents from all claims of damages, demands, actions and injuries whatsoever in any manner arising from my (our) participation in all events. I attest and verify that I have full knowledge of all risks involved in these events and accept full responsibility.

I agree to the above terms.        I DO NOT agree to the above terms.

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