Palm Beach Browns Backers
2020 Membership Application
Single membership: $30 Couples membership: $45
(Couples please submit both names on this form)
Selected payment method:
PAYPAL payments option (this will redirect you to the payment site after submitting this form at the bottom of the page):
( X )
2020 Palm Beach Browns Backers
2020 Palm Beach Browns Backers
FOR VENMO: PLEASE SCAN THE QR CODE ON YOUR MOBILE DEVICE.
For other payment options, please email firstname.lastname@example.org
Name 2 (for couples)
Preferred 1st name on badge (couples enter both):
Hometown (where you grew up)
Street Address Line 2
State / Province
Postal / Zip Code
Contact Phone Number
Please enter a valid phone number.
Are you interested in volunteering?
Only your name & email may be distributed to other club members and to Browns Backers Worldwide. Do you agree?
No (your info will not be shared)
By CHECKING THE BOX BELOW, I agree that the Palm Beach Browns Backers (“PBBB”) only arranges for the use of facilities and is not responsible for the service of food or beverages, including alcoholic beverages, nor for the condition of those facilities. Accordingly, the owner/operator of those facilities is solely responsible for same and I waive any and all claims against PBBB and its officers and other volunteers in such regard. I agree to conduct myself in an appropriate manner at all times and that the owner/operator of the facilities may require me to leave, either temporarily or permanently, based upon inappropriate behavior.
COVID-19 DISCLOSURE,ACKNOWLEDGEMENT & WAIVER
Palm Beach Browns Backers (PBBB) **** Member of Browns Backers Worldwide ****** 2020 Event Venue: Stadium Grill 1203 Town Center Dr. Jupiter, FL 33458
I agree to inform a Palm Beach Browns Backers officer or venue employee if I am experiencing any of the following symptoms related to COVID-19: Cough, Shortness of breath or breathing difficulties, Chills, Muscle Pain, Headache, Sore throat, Loss of taste or smell, Diarreah, Fever > 100 degrees F
I will inform you & not attend any PBBB event for at least 14 days if I develop any of the above symptoms. If I test positive for COVID-19, I will not return to a PBBB event until I receive medical clearance.
I will inform PBBB or a venue employee if I knowingly had close contact with or am currently living with a person confirmed to have COVID-19 within 14 days prior to event.
I certify that I will take my temperature before arriving at the venue/event and it was less than 100 degrees Fahrenheit. I also understand that I am subject to temperature checks performed by a PBBB officer or venue employee.
COVID-19 has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious & is believed to spread from person to person contact. Federal, state, & local governments & health agencies recommend social distancing and indoor capacity restrictions. PBBB is taking steps to reduce the spread of COVID-19; however, Palm Beach Browns Backers & Browns Backers Worldwide CANNOT GUARANTEE that you or your child(ren) will not become infected with COVID-19. Further, attending a PBBB event could increase the risk of contracting COVID-19. By signing this agreement (checking the box below), I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending a PBBB activity and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 may result from the act, omission,or negligence of myself or others, including, but not limited to, Palm Beach Browns Backers officers, and volunteers.I voluntarily agree to assume the foregoing risks & accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death),illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may incur by reason of a Palm Beach Browns Backers event (“Claims”).On my behalf, and on behalf of my child(ren), I hereby release and covenant not to sue Browns Backers Worldwide, Palm Beach Browns Backers, its officers, representatives, employees, agents, and volunteers, of and from the Claims.
Should be Empty: