WELCOME CLUB OF THE FOX VALLEY  MEMBERSHIP FORM

Name:       
Address:   
City:          State: Zip Code:
Telephone  Email address:

Your Birthday Month: Day:
Husband's Name:Moved From (City, State):
Membership Dues and Fees:
    $25.00 for full year (September through August)
    $5 additional if you want your monthly newsletter mailed to you (it will be sent to you via email for free!)                       
    $ 1.00 additional if you wish to have your Club Directory sent you by mail
    $ 6.00 additional if you wish to have a permanent magnetic-backed nametag
                 Print first and last name as you want it on your nametag:               
Total amount enclosed is  We are pleased to have you join us! 

Checks should be made payable to "Welcome Club, Inc." and sent to:

Nancy McNamara 518 Bradbury Lane Geneva IL 60134

 For information, please phone  Nancy McNamara (630) 262-0679 or Ellie Radvanovsky (630) 513-9004.

Check if you wish to receive the monthly newsletter by e-mail. Did you give us your e-mail address?
PLEASE READ AND SIGN THE INSURANCE LIABILITY WAIVER. Thank you.

Please read the form below carefully. A membership application with an unsigned insurance waiver cannot be processed

"I agree to assume the full risk of any injuries, damages or loss regardless of severity which I or my family or guests may sustain as a result of participating in any Welcome Club, Inc. activities. I agree to hold harmless the members of the Welcome Club, Inc. from any and all claims resulting from injuries, damages and losses sustained by me or my family or guests arising out of, connected with, or in any way associated with the activities of any of the programs. I have read and fully understand the waiver and release of all claims.
Member's Signature: Date:
Fill in fields at top of form then submit to your printer

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Last updated 06/08/10