New Member Form

Name (hereinafter "Member")

First

Last

Address

Street Address

Street Address Line 2

CityState

Zip Code

Home

Please enter a valid phone number.Format: (000) 000-0000.

Cell

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

Partial Year

Membership Type

Spouse (if joining)

Children (Under 18 if joining)

Separate with comma (John, George, Paul)

Adult Children (if joining)

Separate with comma (John, George, Paul)

Parent/Gardian

WAIVER AND HOLD HARMLESS AGREEMENT

I, the undersigned, do hereby agree to hold the Coastal Photo Club, Inc. harmless from any liability and claims for damages and injuries of any kind whatsoever, which “Member” might incur or sustain while participating in any of the functions and activities, including trips sponsored by the Coastal Photo Club, Inc. I further agree to hold harmless the Coastal Photo Club, Inc. from liability, loss, cost (including without limit, attorney fees) and other obligations arising out of any such damages and injuries to myself, my equipment, my photographs or my possessions however they occur or are sustained. I further understand that as a member of this club that my personal information listed above will be made available only to other members. As a member of this club, my photographs and photographs of me taken by others may be posted on the club's website. I am responsible to protect my own photographs from piracy on the web by taking the usual precautions. If I provide my website address above, I give permission for it to be listed on the club's website.

Signature: _______________________________ Date: ___________________

Parent/Gardian, if youth: ____________________________

Print form, sign, date, and mail with check to:
CPC Treasurer
PO Box 585
New Bern, NC 28563-0585