Application/Bill for Membership Patriotic Ski Club, Inc.

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I, __________________________________, age ______, hereby apply for membership in PASCA, Inc., a Tennessee not-for-profit corporation, Rutherford County, Tennessee. I understand, if accepted, that I will abide with the by-laws, rules, and regulations of the Club, and furthermore, that I will uphold the Club and the elected and appointed officers. I understand that PASCA, Inc. is relieved of any and all responsibilities pertaining to any injury which I might sustain while performing or participating with the Club and on any Club equipment. Any of my property loss or damage sustained at any time during any Club activity, on or by any Club equipment is also void of Club responsibilities.

SIGNED ____________________________________________ Date: _______________________

PARENT SIGNATURE (If 16 Years or Younger) ________________________________________

Name: ___________________________________________________________________________

Address: ________________________________________________________________________

City: _______________________________________ State: ____________

Zip: ______________

E-mail _________________________________

Would you prefer to receive newsletters via e-mail? Yes _______ No ________

The following information is for the directory:

Phone: (H) _____________________ (W) ______________________ (M) ___________________

Name and/or Brand and Color of Boat(s) _______________________________________________

Family Members to be included (Please indicate if spouse or child):

_________________________________________________________________________________

Send application and payment of $25.00 to:

Susan Titshaw
6175 Browns Mill Road
Lascassas, TN 37085

Please pay membership dues by April 15^th and complete form entirely.
Thank you.