Explorers Club of Pittsburgh

Membership Application and Liability Waiver

Make checks payable to "Explorers Club of Pittsburgh."  Mail to Bill Baxter, ECP Membership Coordinator, 109 Woodhaven Lane., Pittsburgh PA 15237-3712.  If you have any questions, email Bill at BillBaxterECP-Membership@yahoo.com.  NOTE:  Application information (i.e., name, address & phone) is typically published twice per year in the Explorer newsletter. Please print legibly  Include a self-addressed stamped envelope so you will receive your membership card.  

Date of application: / / Type of membership: Individual $20    Family $25

NEW......Complete and submit this form to the Membership Coordinator along with your payment.  Must be 18 years old to join.  Approval of your application by the Board of Governors and the general membership and payment of annual dues entitles you to full membership privileges and a subscription to the Explorer, our monthly newsletter.  Join now and your membership will be valid through December

RENEWAL......Resubmit all address information including an email address and 9-digit ZIP code, reaffirm "person to notify in an emergency", check current activities, newsletter options and sign the waiver.

Name:     

Phone(H):  Phone (W):

Age:    Sex:    Email:      Occupation: 

Address:    Apt#    

City:     State:    Zip: -

Person to notify in an emergency:   

Phone:    Relationship:    

Name (of second applicant for Family membership):     

Phone(H):  Phone (W):

Age:    Sex:    Email:      Occupation: 

Address:    Apt#    

City:     State:    Zip: -

To join the ECP E-Mail Distribution List, visit our WEB site at www.pittecp.org and follow the instructions noted under ECP Listserve.

List any current club members with whom you are acquainted:   ____________________________________________________________________________

What fields of adventure do you wish to pursue?  (Also check current activities you participate in):  

Backpacking & Hiking  Cross-Country Skiing  Ice Climbing Mountaineering Rowing Scuba Diving
Bike Touring Downhill Skiing In-line Skating Rafting Sailing White-Water Paddling
Caving    Flat Water Paddling Mountain Biking Rock Climbing Sea Kayaking   Other _____________________________

 

Please read the following assumption of risk and liability waiver very carefully.  By signing this application you are agreeing to all provisions, implied or otherwise, of the waiver.

IN CONSIDERATION of being permitted to join the Explorers Club of Pittsburgh (ECP) and participate in its activities, I __________________________, for myself, my personal representatives, heirs and next of kin hereby acknowledge, agree, and represent that I fully understand that most ECP activities are very dangerous and that the dangers inherent in such activities, including but not limited to, white water, rock fall, avalanches, crevasses, exposure to severe weather, drowning, equipment failure and the misuse of equipment by myself and others, could result in my suffering serious bodily injury and/or death and I HEREBY:

1.  RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE the Explorers Club of Pittsburgh, the instructors and/or participants in any teaching activities, and/or any of the individual officers or members of the ECP (hereinafter collectively referred to as "releasees" from all liability to me, my personal representatives, assigns, heirs and next of kin for any and all loss or damage, and any claims or demands therefore on account of injury to my person or property or resulting in my death whether caused by the negligence of the releasees or otherwise while participating in any activities conducted by the ECP and/or any of its individual members.

2.  AGREE TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to my participating in any way in any activities conducted by ECP and/or any of its individual members whether caused by the negligence of the releasees or otherwise.

3.  ASSUME FULL RESPONSIBILTY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while participating in any way in any activity conducted by the ECP and/or any of its individual members.

I further expressly agree that the foregoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Commonwealth of Pennsylvania and if any portion thereof is invalid, it is agreed that the balance shall, not withstanding, continue in full legal force and effect.

I HEREBY WARRANT THAT I HAVE READ AND VOLUNTARILY SIGNED THIS RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

SIGNATURE ______________________________________________________________________________________ DATE ___________
SIGNATURE ______________________________________________________________________________________
(of second applicant for family membership)		 DATE ___________

The assumption of risk must be signed before a membership card can be issued.  Cards will be mailed in your self-addressed, stamped envelope.   Otherwise, they will be distributed at the December General Meeting.