Membership Form

Our preferred method of new and renewed member registration is using the Join link (also found above) to submit your registration electronically.   But if you prefer to send you membership form by postal mail that is fine, too. Please note that sending your registration by mail does NOT register you online.   Online registration needs to be done by YOU, and we will approve your online mebership after we receive your payment all renewal notices are via email, if you fail to supply an email address you will not be reminded to renew.

 

To Renew Your Membership: Either go to the bottom of the page to pay securely via PayPal or complete this form and send it along with a check payable to "Chiltern Mountain Club", (note: you must include an email address on the form to be notified of your acceptance and it can take 4 or more weeks for the form to be process and the check to be deposited) to:

Chiltern Membership

P.O. Box 850711
Braintree, MA 02185-0711

Membership is annual based on receipt of payment and a signed membership form.  Membership in Chiltern is open to any gay, lesbian, bisexual, transgender, queer person, their friends and other queer-friendly persons. The minimum age for membership is 18. A parent or guardian must accompany those under 18 years of age who wish to participate in Chiltern activities.

Membership Type: Single ($25/year) Dual ($50/year)

Check here ________ if this is a renewal.

1st Member Info:

Name: _____________________________________________________________________

Street Address: ______________________________________________________________

City:___________________________ State: _____________

Zip:_____________________ Home Phone: __________________________ Work

Phone: __________________________ Email:

_____________________________________________________________________ 2nd

Member Info (for dual-membership): Name:

_____________________________________________________________________

Street Address: ______________________________________________________________

City:___________________________ State: _____________

Zip:_____________________ Home Phone: __________________________ Work

Phone: __________________________ Email: _____________________________________________________________________

How did you hear about Chiltern? ________________________________________

Payment of club dues to Chiltern Mountain Club entitles me to the benefits of membership. I agree to familiarize myself, and abide by the by-laws and policies of the Chiltern Mountain Club. I understand that participating in outdoor events can sometimes be dangerous and I agree to assume all risks associated with my participation in events sponsored by, or publicized by Chiltern Mountain Club. Chiltern Mountain Club leaders run events on the express condition that Chiltern Mountain Club, its members and leaders shall not be held responsible for any personal injury, damage, loss of property, accident or other loss of any kind, whether alleged to be caused by act or omission. I hereby release and hold harmless Chiltern Mountain Club, its leaders and any and all of its members from any and all claims, causes of action, or liabilities related to events where I am a participant.

Signature of 1st member: _______________________________________________

Printed name:________________________________________________________

Date: ______________________________________________________________

Signature of 2nd member:_______________________________________________

Printed name:________________________________________________________

Date: ______________________________________________________________