AEA Scuba Club Membership Application

Year: 

Personal Information
====================

Family Name:
     
First Name:
     
Address:
     
City:
     
Zip:
     
Mail Stop:
     
Email:
     
Hm Phone:
     
Wk: Phone
     
Fax:
     
Affiliation:  __ Aerospace, __ Air Force, __ Other


Certification Information
=========================
 __ PADI
 __ NAUI
 __ NASDS
 __ LA County
 __ YMCA
 __ Not Certified
 __ 
     
Certificate Number: 
     
Year Certified:
     
Certification or Skill Level:
     

Dues
====
 __  $10.00 For Aerospace Employees
 __  $12.00 For Air Force Employees
 __  $12.00 For All Other Members
 __  Annual Membership Already Paid (paid after 1/1/2001)


Waiver
======

I, THE UNDERSIGNED, HEREBY APPLY FOR MEMBERSHIP IN THE SCUBA CLUB 
(“CLUB”) OF THE AEROSPACE EMPLOYEES’ ASSOCIATION (“AEA”) AND AGREE TO 
ABIDE BY ALL CLUB RULES.  I ACKNOWLEDGE THAT I WILL BE VOLUNTARILY 
PARTICIPATING IN CLUB ACTIVITIES WITH FULL KNOWLEDGE OF THE DANGERS 
INVOLVED.  IN CONSIDERATION OF YOUR ACCEPTANCE OF THIS APPLICATION AND MY 
MEMBERSHIP IN THE CLUB, I AGREE TO ASSUME ALL RISKS OF BODILY INJURY, DEATH 
OR PROPERTY DAMAGE, ARISING OUT OF OR IN CONNECTION WITH MY PARTICIPATION 
IN CLUB ACTIVITIES.  I ALSO AGREE TO RELEASE, INDEMNIFY, DEFEND AND HOLD 
HARMLESS THE CLUB AND THE AEA, AND THEIR MEMBERS AND OFFICERS, FROM ANY 
LIABILITY ARISING OUT OF OR IN CONNECTION WITH MY PARTICIPATION IN CLUB 
ACTIVITIES.  I FURTHER AGREE THAT THIS RELEASE AND INDEMNIFICATION IS 
INTENDED TO BE AS BROAD AND INCLUSIVE AS IS PERMITTED BY THE LAWS OF THE 
STATE OF CALIFORNIA.  I HAVE CAREFULLY READ THIS RELEASE AND FULLY 
UNDERSTAND ITS CONTENTS.  I SIGN THIS RELEASE OF MY OWN FREE WILL WITH FULL 
KNOWLEDGE OF ITS SIGNIFICANCE.


SIGNATURE: __________________________________________	 DATE: ______________

Return Hard Copy with Signature and Dues to Ed Serhal, M4-934.