Join Eagle Audubon

Eagle Audubon Society Membership Form

Yearly Membership $10 per person – October 1 – September 30

Please complete the following Information 2020-2021

Name(s)_________________________________________________

Street___________________________________________________

(Local Address)

City_____________________________State____________Zip_____

Telephone____________________Kings Point: Yes______ No________

Email address_____________________________________________

Off Season Address (if any)

Name(s)_________________________________________________

Street___________________________________________________

City__________________________________State________Zip_____

Telephone____________________________

Email Address_________________________________________________

LIABILITY AND PHOTO RELEASE*

*In the event that we are able to hold in-person field trips during the 2020-2021 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 assignees, 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.

Member Signature________________________________Date______

Member Signature________________________________Date______

Please mail completed membership form and check for $10.00 per person payable to Eagle Audubon Society to: Nina Malinak 2424 Kensington Greens Drive Sun City Center, Fl 33573

 

Comments are closed.