MEMBERSHIP FORM

  Amount
Joining Month
 
 
Jan-Jun
Jul-Dec
SFBC Membership *
_______
$18
$15
Optional Paper Newsletter
_______
add $12
add $6
Optional Additional Family Members
_______
add $7
add $4
Optional Donation to Grant Fund
_______
(Supports grants for cave purchases, conservation, etc.)
Total
_______
 
 
Note: Reduced rates are not applicable to current members.

* Includes an electronic copy of the SFBC newsletters. Also includes $10 for 12 months of Western Region membership including the California Caver newsletter.

Membership includes an electronic copy of the SFBC newsletters. It also includes $10 for 12 months of Western Region membership, including the California Caver newsletter. If you hav alrady paid Western Region dues for the current year, substract $10 from the membership price listed to avoid duplicate payment. (Note: NSS membership is required to be a member of the Western Region and a regular member of the SFBC. Non-NSS members are associate members of the SFBC and subscribers of the Western Region.)

Date _____________________________     NSS Number _______________________

Member's Name ____________________________________________________

If currently a SFBC member, show address corrections below as needed.

Address ____________________________________________________________

City __________________________________________________

State ________________________     Zip + 4 _____________________

Home Phone _______________________     Work ________________________

E-mail Address for Newsletter Distribution _____________________________________

[   ] Don't public address in grotto roster   [   ] Don't publish phone number in grotto roster

[   ] My primary affiliation NSS Internal Organization is not SFBC, it is:____________________________
(Note: that you must change this yourself via the NSS web site.)

Immediate Family Members  (if option paid for above)

Name ______________________________     E-Mail ___________________________

Name ______________________________     E-Mail ___________________________

Name_______________________________     E-Mail____________________________

San Francisco Bay Chapter : N.S.S. Release of Liability

It is hereby declared and agreed between the San Francisco Bay Chapter of the National Speleological Society (hereafter referred to as the S.F.B.C.) and the undersigned the following terms and conditions.

1. I am aware that caving contains inherent risks of injury to me personally and damage to my equipment. These risks may be caused by: road hazards traveling to and from caves, variable conditions which may be found in caves, equipment failure or misuse, my own negligence or the negligence of others, accidents traveling to and from a cave; and can cause serious injury or death. Caving is hazardous because; even if the caver is knowledgeable, environmental conditions found in caves, such as variable water levels, loose, unstable or slippery rock, cold temperatures and uncertain air quality may lead to dangerous situations. In addition, injury can occur due to equipment failure or misuse, my negligence, the actions of another caver within my party, or of third parties, which may be present.

2. While the S.F.B.C., may at its discretion, require demonstration of proficiency with single rope techniques and with the use of various caving or climbing equipment or techniques prior to allowing an individual to participate in certain trips, the responsibility for the proper use of such equipment or techniques must remain with each individual. Failure by the caver to use or maintain equipment properly can result in serious injury or death.

3. Knowing these facts, I, nevertheless, in consideration of the acceptance of this agreement by the S.F.B.C., hereby agree for myself, my heirs, executors and administrators, to assume the risks of these and similar dangers and waive any claims against, and release and forever discharge the S.F.B.C. and its officers and members and their heirs, executors and administrators and assigns, from any and all injuries that might be sustained by me or any and all claims of any kind or nature that I might have as a result of, or arising out of my participation in any S.F.B.C. trip or events.

4. This release will extend to any accident, damages or claims whether arising out of my own acts or the acts of others, which have resulted in injury to me. I am aware that caving is a hazardous activity. I am voluntarily participating in this activity with knowledge of the dangers involved and hereby agree to accept any and all risks of injury or death. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between myself and the San Francisco Bay Chapter and I am signing it of my own free will.

Note: If signature of guardian is applicable, please sign below the minor’s name and indicate properly!

Signed: ___________________________________________________________________

Print Name: _______________________________________________________________

Guardian: _________________________________________________________________

Address: __________________________________________________________________

Date: ____________________________________________________________________

Email: ___________________________________________________________________

Phone #: _________________________________________________________________

Emergency Contact Person: _____________________________________________________

Address: _________________________________________________________________

Phone#: _________________________________________________________________