Michiana Outboard Boating Chapter of AOMCI
Membership Application Form
Your Name (Print Clearly): ____________________________________________________________________
Street Address: _____________________________________________________________________________
City/Town: _________________________ State/Providence: ________________________________________
Country: ___________________________ Phone Number: (Area Code _____ ) _________________________
Other Information: ___________________________________________________________________________
__________________________________________________________________________________________
I am current member of the Antique Outboard Motor Club.
Check one: (_) Yes (_) No
Dues are $10.00 U.S. per year beginning in January with the membership expiring in December of each calendar year. You will receive Meet Notices in newsletter format. You must be an AMOCI member to be eligible for MOB Membership. You MUST read the liability release below carefully and sign at the bottom.Mark Majcher
Box # 788
Hebron, IN 46341
LIABILITY RELEASE
The undersigned person, by signing this document, does agree to assume all responsibility and liability for all his act or activities, including any and all acts involving his assistants or crew, and for any and all damage or injury that may be caused by any or all of them or by his boat or motor or other property or possessions. The undersigned person does hereby release M.O.B. and any organization sponsoring, assisting, or granting permission for activities, together with their successors, assigns, officers, agents, assistants, representatives, employees and spectators from any and all liability, claims, demands, and causes of action whatsoever which the singer may have or which may accrue in his favor against them or any or either of them in any way growing out of or resulting from said act, acts or activity or in connection with any vessel, dock, float, barge, equipment or facility provided or used, whether or not same may be operated or controlled buy them and whether arising while in preparation or practice, while participating in controlled activities or informal activities, or subsequent thereto the singer assumes all risk of injury and damage to the person and property of himself and his assistants and guests, whether caused by negligence or otherwise, and said signer agrees that no other agreement whether oral or written shall in any way affect his release. Furthermore, said signer certifies to the truth of all statements made and agrees to abide by all rules and to accept as final, all decisions of properly authorized officials.
In witness whereof, the undersigned has hereunto set his hand and seal the day and year written below
Date______________ Sign Here ____________________________________