Eagle Audubon Society Membership Form
Yearly Membership $15.00 per person – October 1 – September 30
Please complete the following Information 2021-2022
Telephone____________________Kings Point: Yes______ No________
Off Season Address (if any)
LIABILITY AND PHOTO RELEASE*
*In the event that we are able to hold in-person field trips during the 2021-2022 season
By this agreement, I the undersigned, have voluntarily applied to participate on field trips sponsored by the Eagle Audubon Society. I expressly assume the risk of any harm that might occur directly or indirectly from travel to and from the field trip site and from any harm that might occur directly or indirectly from any forces of nature or wildlife that I may be exposed to that causes me injury.
In addition, on behalf of myself and my assignee’s, heirs, personal representative and legal representative, in consideration of the opportunity to participate and attend the field trips organized by the Eagle Audubon Society and being eighteen (18) years of age or older, I hereby agree to release and hold harmless the Eagle Audubon Society, and the National Audubon Society.
I grant the Eagle Audubon Society, its representatives and members the right to take photographs of me and my property in connection with field trips or other activities of the Eagle Audubon Society. I authorize the use of same in print and/or electronically.
Please mail completed membership form and check for $15.00 per person payable to Eagle Audubon Society to: Julie Stocksdale 256 Silver Falls Drive Apollo Beach, Fl 33572